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Posts published in June 2015

Missed opportunities

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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 does not cost states. Yet states are setting the rules, so at the very least our advocate ought to be chronicling the impact. 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.

First take

Think about it and it seems increasingly remarkable, and indicative: The first major Spanish-language radio station in the Magic Valley is celebrating its first year in business, and it held a celebratory event at the Jerome County Fair. Okay, fine; no big deal. Except, according to the Twin Falls Times News, "thousands of people" showed up for it. How many businesses, or much of anything else, would draw people by the thousands in an area of that size? (Jerome itself only has but so many thousands of people.) This is speaking pretty strongly both to the numbers of Hispanic people in the Magic Valley, and in Idaho. It also speaks to the culture taking hold there in a serious way.

What people in other countries think of us ought to always be of interest - not by way of telling us what to do, but by way of giving us an alternate lens for how we look at ourselves. Foreign Policy has an amusing article on what other governments tell their citizens about what to watch out for when they visit the United States. It's definitely a different way of looking at the country than most of us here have (and say a lot about those counties too).

Energizing Vista?

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I have been a resident and home owner of the Vista Neighborhood for nearly 50 years. Over that half century I have watched as Boise’s city fathers and mothers–past and present–have dumped house trailers, low cost housing, sex offenders, skinny houses, refugees, and assorted “assistance programs” in our neighborhood.

To be fair, for the most part these deals were probably well intended. The latest plan is a high dollar deal to “Energize Vista.” To be realistic, most of the deals have flaws. To be cynical, there is probably little hope of any true “improvement.”

Boise City in cooperation with the Farmer’s Market downtown has begun to compete directly with Lowe in an effort to “bring nutrition” to the poor folks living in the Oak Park apartments near Cherry Lane and Vista. The City is subsidizing a refrigerated trailer stocked with fresh produce that makes stops at the apartment complex–much like the Schwan’s frozen food guy. We think a free taxi or shuttle to Lowe’s market would be cheaper.

“The city never contacted me and I will have trouble staying open if these guys from downtown come into my area with subsidized competition,” lamented Lowe.

Pointing across the street to a rental property and a pair of skinny houses he added, “Those houses have never had anyone in them more than a year. We establish a customer base and they all move away.”

There in lies the problem. Skinny houses are allowed with multiple tenants–usually college students. Granted, the structures are probably visual improvements over the original structures, but cars are parked helter-skelter along the street and the occupants are transient in nature. The houses don’t attract upscale occupants.

Meanwhile, Boise planners and politicos proudly tout their efforts at creating upscale housing in the downtown area where taxes on improvements are all diverted away from all local governments and schools to benefit CCDC and developers. - from Boise Guardian

First take

What the Oregonian pointed out today about pot sold in dispensaries, that traces of pesticides have been found in it, is not surprising and actually one of the arguments for legalizing it. Up to now, with pot grows being illegal, the operating principle had to have been that the fewer eyes on it, the better. Now reviews can be undertaken in sunlight, and cannabis likely to be a great deal safer.

On another pot front, that House bill barring the U.S. Department of Justice from messing with state laws allowing legalized marijuana, which passed that chamber, now has passed the Senate Appropriations Committee, placing it in a budget bill. Chances of passage into law are now . . . high. This would be the first significant rollback in federal law against pot ever, really, and may turn out to be a very big deal when the history of this prohibition is written down the road.

New chair

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A miracle of sorts is developing among Idaho’s Democrats: A three-way contest for the position of party chair.

Call that a small but real mark in the plus column for the Democrats, along with the fact that, unlike the last state Republican chair contest, this one has foregone bitterness or battles. But then, this isn’t a job most people would want. It doesn’t pay, but it can be time consuming and intensely absorbing. The end results of those efforts are likely to be – however adept and hard-working the chair may be – crushing defeat and blame, generally undeserved.

The Idaho Democratic chair has attracted some highly skilled political people over the years, but it has limited authority and is commonly thought to be something much closer to “powerful” than it actually is. (Same goes for the Republicans.)

Still, the chair can influence politics in the state to a degree. This is written before the vote electing the new chair, so I don’t know who it will be, but the advice that follows would apply to any.

Party chairs (any party) have two basic useful functions: Building and strengthening the organization, and serving as its spokesman to the public. (They sometimes play a role too in candidate recruitment, which Democrats in recent cycles have done relatively well.) With that in mind, three ideas suggest themselves for the incoming Democratic leader.

1. The top organizational priority should be filling precinct spots. Form a special task force and chair it, with the specific goal of filling as many of those precinct vacancies as possible around the state. And then give those precinct people some specific and visible work to do.

With focused attention, more can be done in this area than most Idaho political people think. In the 2014 election the Republican candidate for governor, C.L. “Butch” Otter, won by a big margin. Care to guess in how many out of about 1,000 precincts his Democratic opponent, A.J. Balukoff, got no votes at all? I counted only three. There were lonely Democrats casting their defiant votes in very nearly every precinct and in every county in Idaho. The chair should be setting out finding those scattered seeds, carefully planting and watering them.

2. Use such bully pulpit as you have first and foremost to describe what the Democrats are about. Not, that is, about what this or that individual Democrat is proposing: Your job should involve defining the party and what it wants, as distinct from the Republicans, and spreading the word. A whole lot of Idahoans have been given to think Democrats are the spawn of Satan, and that’s not much exaggerated. Democrats in Idaho will continue to lose until this starts to change.

3. Use your position to talk about the Republican Party and what (in your view) it’s all about. Not just the latest bum headline, not just this office holder or that one, but the party itself. And not the fact that it controls all the political levers in Idaho – that just sounds whiny. And certainly not that “we need two parties.” (That offers no help about why anyone should choose yours.) Talk about why you think Democrats are right and Republicans are wrong. And you should be just that blunt.

Whoever you, the next chair, turns out to be, you’ll probably get more blame than you deserve whatever you do. But there is some potential for at least making the job count.

First take

What's your demonym - for your community, that is? Subject came up at the Salem Statesman Journal, where a write pointed out that few people seemed to know what to call a resident of Salem. Salemite? That seemed to be the closest to a consensus, but it's not commonly used there. It doesn't trip off the mind the way Portlander or Seattleite or even Boisean do. Could have something to do, the article seemed to suggest, with the way people look at the community: Demonyms probably come up more easily when people like to talk about themselves as community residents, and while Salem is a nice community (underrated, I think), there is an in-the-shadow-of feeling there. No, they're not Portland, but then they don't have to be. Our town here, Carlton, is far smaller than either Salem or Portland, but the self-description of Carltonian flows easily.

A cancerous national attitude

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Two disparate story lines in our living rooms these days seem - at least to me - twin warnings about one of the most dangerous failures occurring in our society. Ignoring fact, while believing lies. Maybe you’ve put it together, too. It’s a seeming connection between Benghazi and police shootings.

The dangerous commonality is this: in both cases, hardcore groups have - without fact or even in the face of fact - determined an outcome and will accept no other. Until either faction sees headlines supporting their view - accurate or flat earth crazy - neither will surrender to any other reality.

In the case of Benghazi, there’s that kamikaze mentality among Republican loons that they’ve been lied to from the get-go. They absolutely “know” they’ve been deliberately deceived by Democrats who’ve “destroyed evidence” while creating a Satanic lie about what happened that fateful night in Libya. They “know” “murders” of American heroes have been covered up to save face for the Obama administration. They’ll accept nothing less - not one penny short - of the full “truth” they and they alone have seen since the shots were fired. Benghazi was treason!

And facts? Well, facts be damned! But FACTS there are. And if you know none of the others by which to make a rational, informed decision about Benghazi, all you need to know is ONE fact: there have been six - six - full-on, quite independent investigations costing tens of millions of dollars. The same event has been microscopically examined - beginning-to-end - by a State Department team - another by the Defense Department - a bi-partisan congressional oversight committee - an independent blue-ribbon group given total access to all information held by anyone - two exclusively by Republicans in one guise or another - and the seventh - another Republican witch hunt is currently working feverishly with spades in hand.

But it’s that sixth top-to-bottom scouring by Republicans - led by one of the most Democrat-hating GOPers - that should have buried Benghazi once and for all: the Issa committee. After two years trying to find something - a shred of incriminating evidence against anyone not of the Republican cloth - this last effort to find proof of a foregone belief of “treachery and treason” should have slammed the door. No evidence. Against anyone. Of any political persuasion. None. Zip. Nada. Officially. In writing!

No. No, now there’s yet another GOP-led group going at it again. No matter Issa and his minions have contaminated any future finding from this new bunch. The sounds of shovels can still be heard in the night coming from the GOP caucus room. Supporters - Limbaugh, Beck, Lindsey Graham and others - wait outside in the dark - pitchforks at hand and torches ready to light. They - and only they - know the Benghazi “truth.”

Then Ferguson. And Boston. And Cincinnati. And New York. Nowhere can you find better “how-not-to” examples of ignorant police administration and conduct. Nor a more treacherous display of prosecutorial abuse of office than we’ve witnessed in Ferguson. Conduct of local authorities that’s plainly outrageous. Some will be - and some are- the focus of outside investigations and there’ll be more than a few prosecutions.

And that Benghazi link? As in the case of those determined to create “facts” to justify their absolute certainties of what happened in Libya, so too, in these police shootings, many folks simply decided what “really happened” and will accept nothing less than support for what they “know.” Nothing.

The Benghazi-like similarity I see is with those in the Missouri, Ohio, New York, Pennsylvania streets who - like the D.C. witch-hunters and others with conspiratorial mentalities - will not accept any outcome of any case differing one iota from “facts” they alone know. “Truths” they alone “understand.” Many - far too many - of these folks are unable or unwilling to deal with reality.

When people are determined to disbelieve, they will disbelieve. No amount of fact - no amount of evidence - no amount of truth will alter perceptions. All that can be done is for reasonable people to make reasonable efforts and, when that is done, move on. Talk time is over.

With unlimited resources and the power of federal subpoenas in both hands, Darrell Issa could not overcome the true facts of Benghazi. A superhuman effort in pursuit of an outcome that didn’t exist was a monumental waste of time and money. The destructive crowds in city streets are on a similar fool’s errand.

Issa had only the court of public opinion left. He lost there. Credibility. Integrity. Worthiness. Any residual value to his constituency. He’s a liar and a fool and will have to console himself with just being the richest member of Congress.

Protestors of police actions - if their protests are legitimate - have at least state and federal laws to stand upon and can attract other, more informed and more honest government and private support to their side. They still have a future in which they can prevail. And, maybe change some minds.

But not if they continue to follow other “Issa” delusionists and hold to “facts” legitimately discredited by truth. Reality is not Fox “News.”

First take

There'll be a lot more of this to come, but I found today's Charles Krauthammer column of some interest (and that's not so typically the case) as a differentiator of the many Republican candidates: Who's in the top rank, who's just below that, etc. Krauthammer's take: On top - Jeb Bush, Scott Walker, Marco Rubio, based on polling and money; Second rank - Rand Paul ("high floor, low ceiling"), Ben Carson; Third rank but prospects for growth - Ted Cruz, John Kasich, Carly Fiorina; and, seeking divine intervention - Rick Perry, Chris Christie, Mike Huckabee. Best line: That Perry is on "24-hour gaffe watch." My take: all of these candidacies are built on sand but I'd especially down-rank Carson and Fiorina. One other thought: With Iowa Republicans cancelling the summer straw poll this year, the off-the-top-of-your-head analysis like these surely will proliferate.

The number of people answering "none" to the question of "what's your religion" has been growing rapidly in just the last few years and is picking up steam. After many years in which the "nones" were reported in mid-single digit percentages, the number has been shooting upward of late, reaching - in the new Pew Research Center poll - about 23%. That happens to be more than the number of Roman Catholics in the United States. Speculation here is that this reflects not so much a change of attitude or belief as it does a willingness to give the "none" answer: In many places across the country, being unchurched is just socially unacceptable. Maybe not so much any more, and the numbers may indicate the approach of a tipping point. If so, it could be in line with the way several other social questions have gone in the last decade or so.

Where Native voters weigh in

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The first ballots for the 2016 presidential election will be cast in a little more than seven months. That means between now and January there will be a rush of candidates, a winnowing of those who fail to raise money or attention, and, if we are lucky, a philosophical and practical debate about the challenges facing the United States.

In an ideal world that discussion would include American Indian and Alaska Native concerns. But that never happens (unless you read between the lines).
So the Democrats — Former Secretary of State Hillary Clinton, Vermont Sen. Bernie Sanders, former Maryland Gov. Martin O’Malley, and the newest entrant, Rhode Island Gov. Lincoln Chafee (who once was a “liberal” Republican) — campaign on issues ranging from protecting and expanding voting rights to switching the U.S. to the metric system.

And the Republicans? Well, just listing the candidates is kind of like making sure you get all the names right when reporting about a school play. There are so many, you’re bound to miss someone. But here goes (in order of recent polling by Real Clear Politics): Former Florida Gov. Jeb Bush, Wisconsin Gov. Scott Walker, Florida Sen. Marco Rubio, Dr. Ben Carson, Kentucky Sen. Rand Paul, former Arkansas Gov. Mike Huckabee, Texas Sen. Ted Cruz, New Jersey Gov. Chris Christie, Donald Trump, former Texas Gov. Rick Perry, Ohio Gov. John Kasich, former Penn. Sen. Rick Santorum, Carly Fiorina, South Carolina Sen. Lindsay Graham, and Louisiana Gov. Bobby Jindal. And that’s only the 15 “major” candidates. So in order to make noise in that large a field some of those would-be presidents rode Harley’s across Iowa this weekend, revving up their engines and their rhetoric. Hardly the right atmosphere for a discussion about tribal sovereignty.

The early primary campaign season is not ideal for a serious discussion about Indian Country’s issues. The election calendar starts with Iowa, New Hampshire and South Carolina in late January.

Nevada will be the fourth state to vote — and the first state with a significant tribal population. There are more than thirty reservation communities, urban residents, and a total Native American population of about 1.6 percent. More important, Nevada remains a caucus state. So if a large number of Native Americans show up in the right locations, well, all bets are off. (Only 33,000 Republicans voted in the last Nevada caucus out of some 400,000 G.O.P. voters.)

And what if there was a Native candidate as a draw? This ought to be the year to make that so.

A Native American candidate could take advantage of a nasty, undemocratic (but legal) structure. The law allows secret donors to spend unlimited sums of money to benefit a single candidate. So what if a few of the wealthy tribes, and, yes, I do mean casino tribes, raised a lot of money for such a super PAC? (Even though the money cannot go directly to a candidate, it still has been used to boost candidates. In 2012, for example, former House Speaker Newt Gingrich was on the receiving end of more than $15 million from casino owner Sheldon Adelson and his wife.)

Coming up with a super PAC candidate from Indian Country is a tough sell for Democrats. Even though there are many folks who could (and should) be candidates, there are too few with a large enough political footprint. And taking that much money from a single source runs against what many grassroots type candidates believe anyway.
But on the Republican side, there is someone who has that credibility right now, Rep. Tom Cole of Oklahoma, a member of the Chickasaw Tribe.

Cole is as conservative as his Oklahoma voters yet he is often the voice of reason in the House of Representatives. He’s said that new revenue — meaning taxes — might be needed to get past the sequester and that repealing the Affordable Care Act might not be possible as long as a Democrat is in the White House. This alone distinguishes him from the other fifteen Republican candidates running for president.

He’s championed tribal sovereignty and was a key player in the House vote for the Violence Against Women Act. Let me be clear here: Cole fits the orthodoxy of the Republican Party. He supports pipeline construction and increasing oil and gas production. Cole also wants less federal spending and votes for budgets that would have negative impact on tribal communities. But for a Republican primary, and for a Republican candidate, Indian Country would still come out ahead, if he were running and raised the issues in Indian Country that call out for a larger debate.

The down side of a Cole candidacy is that he would have to give up his seat in the House — and his seniority and influence. That’s probably too high a cost for an improbable presidential quest. But this might be the year to try something outrageous.

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.

First take

Whatever your religious views, this much about the Bible should be clear and broadly acceptable: It is great literature and full of flourishes of brilliant use of language. High profile atheists routinely have said as much. And for that reason there's a clear case for placing the Bible in schools as a reference. But it's not equally useful for everything. The Idaho Republican Party last weekend proposed the Bible be “expressly permitted to be used in Idaho public schools for reference purposes to further the study of literature, comparative religion, English and foreign languages, U.S. and world history, comparative government, law, philosophy, ethics, astronomy, biology, geology, world geography, archaeology, music, sociology, and other topics of study where an understanding of the Bible may be useful or relevant.” Comparative religion? Okay. Comparative government? Debatable at best. Philosophy? As one source among others, could be. But astronomy? (Does anyone remember Galileo?) Geology? Biology? Music? You get the sense the agenda here runs something beyond what most of us think of as education.

Where did the early inhabitants of Europe come from? Apparently from Russia, around 3000 bc, and with a genetic switch that made cow milk drinking practical. Another piece of history filling in.