Writings and observations

trahant MARK
TRAHANT

 
Austerity

The adjective of the day is “modest.” That’s the standard phrase to describe the $1.012 trillion spending bill for a federal fiscal year that has less than nine months left. The bill gives modest relief from the sequester. There are tiny (I can’t bring myself to say “modest” even in jest) increases in some federal programs, including the Indian Health Service and the Bureau of Indian Affairs, and it puts off the fight over the size and nature of government until another day.

This is the Budget of Meh. It better reflects a broken governance structure than it does true spending priorities. Neither the right, those who want to shrink government, nor those of us who want to the government to invest in key program areas can claim victory. Meh.

This budget reflects a continuing trend of austerity. The federal government is shrinking. Sort of. And austerity rules.

House Appropriations Committee Chairman Hal Rogers, R-Kentucky, took credit for this idea in his news release about the compromise spending plan. “The Omnibus will fulfill the basic duty of Congress; it provides funding for every aspect of the federal government, from our national defense, to our transportation systems, to the education of our kids,” Rogers said. “The bill reflects careful decisions to realign the nation’s funding priorities and target precious tax dollars to important programs where they are needed the most. At the same time, the legislation will continue the downward trend in federal spending to put our nation on a sustainable fiscal path.”

But Rogers’ line of thinking is misleading. This huge, 1,500-plus page spending bill, only covers federal dollars that are appropriated, about one-third of the budget. This is the budget that’s shrinking, while two-thirds of the budget continues untouched on an automatic pilot, including Social Security, Medicare, Medicaid, Children’s Health Insurance and, I hope, money that is pumped into the Indian health system through the Affordable Care Act.

So for Indian Country the appropriations process is broken beyond repair; business as usual is no more. The federal programs that have served Indian Country well are essentially continuing to shrink. The Omnibus budget, for example, shows an increase of $18 million for the Bureau of Indian Affairs. Eighteen million! Wow. In percentage terms that’s less than one percent. The IHS increase is under 2 percent.

If that sounds modest, consider that the amount includes a one percent raise for federal employees as well as services for a growing population. The population increase for Indian Country last year was about 1.5 percent (about twice the rate of the general U.S. population.) The case is clear that we, as a country, should be investing in younger American Indians and Alaska Natives. This is the time to create opportunity, both in terms of education and jobs. Instead all we can muster is that collective “meh.”

This trend will not change unless Congress changes. Radically. The idea driving austerity is bipartisan in nature. And, even though the problem with federal spending has very little to do with annual appropriations, that’s where the action has been. We could zero out this side of the budget and there would still be a long-term spending problem.

But for Indian Country there is opportunity in this budget. We must add as many Indian health dollars as possible to the entitlement category. To make that happen, there needs to be a much stronger campaign to educate American Indians and Alaska Natives about the disaster that is appropriations — and show how and why the Affordable Care Act is the alternative. Signing people up for health insurance of any kind is Indian Country’s patriotic act because it defies those who would cut us into oblivion.

In its budget justification to Congress, the Indian Health Service projected a modest (there’s that word again) increase in third-party billing, Medicare, Medicaid and private insurance. The total is just over a billion dollars. What if that number doubled? That’s a billion dollars that does not have to be appropriated by Congress. A billion dollars to actually invest in a healthier Indian Country. That’s a billion dollars that won’t be reversed by dwindling appropriations.

Or we can stick with budgets of meh.

Mark Trahant is the 20th Atwood Chair at the University of Alaska Anchorage. He is a journalist, speaker and Twitter poet and is a member of The Shoshone-Bannock Tribes. Comment on Facebook at: https://www.facebook.com/TrahantReports

Share on Facebook

Trahant

trahant MARK
TRAHANT

 
Austerity

It’s a new year — and a new story. There is nothing more important to political discourse than a good story. It shapes our thinking, sets the rules for the debate, and, sometimes, warps reality. Stories matter. We humans think in terms of story. We dream, tell, and remember stories. We live stories.

So what’s Indian Country’s “story” for 2014?

Before I answer that question, let’s look back at recent narratives.

The first story goes like this: Congress broke promises made to Indian Country by cutting federal budgets beyond all reason, especially through the sequester. This made reservation life far more difficult, removing children from Head Start, scaling back educational opportunities, severe funding for healthcare delivery, and basic government infrastructure.

The New York Times, in a July editorial, captured this storyline. “It’s an old American story: malign policies hatched in Washington leading to pain and death in Indian country. It was true in the 19th century. It is true now, at a time when Congress, heedless of its solemn treaty obligations to Indian tribes, is allowing the across-the-board budget cuts known as the sequester to threaten the health, safety and education of Indians across the nation.”

This is an important story to know. And to tell. But it’s also important to know that the story already has its ending. There are only two ways to change what happens next, vote out Congress or limit the damage. (More about both of those scenarios in future columns.) The second alternative is remote, but possible in 2014, with measures such as Montana Senator Jon Tester’s bill to fund Indian health programs a year in advance.

Another story told this year is about changing the name of the Washington NFL team. This story is important because it’s a success story (I know, the issue isn’t resolved. Yet. But it’s inevitable. The question is how long the team owner will fight on, not the outcome.) Forget the merits of the mascot debate for a minute and just think about the storytelling aspect.

This story is all about the long view. Suzan Shown Harjo, Raymond D. Apodaca, Vine Deloria, Jr.; Norbert S. Hill, Jr.; Mateo Romero; William A. Means; and Manley A. Begay, pressed a case calling for the cancellation of the team’s trademark protections. It’s step-by-step litigation that’s built a through record about “pejorative, derogatory, denigrating, offensive, scandalous, contemptuous, disreputable, disparaging and racist designation for a Native American person.”

The velocity of change picked up in February when the National Museum of the American Indian held a public symposium on the mascot issue. This was a story told in the heart of Washington, challenging and burying status quo.

So much so that Harjo and her allies have already won the tides of history and public opinion. The NFL doesn’t see it that way. Yet. But it will will. And if not, the litigation continues in a new form, the case now known as Blackhorse et al v. Pro-Football Inc. This is a story that’s ready for an ending.

A third story — another one about success — is the signing into law of reauthorization of the Violence Against Women Act, including provisions that recognize tribal jurisdiction. This law is a tribute to the power of story. It probably would not have become law until Deborah Parker, Vice Chairman of the Tulalip Tribes, told her story to Sen. Patty Murray and then in a Senate news conference. Parker’s narrative changed the politics. The law’s supporters built a successful coalition that trumped the politics of the ordinary, especially in the House of the Representatives. This Violence Against Women Act story, though, needs an ending. It’s not enough to pass a law, there has to accounts about how this law has really made a difference in the lives of women are abused.

One problem with stories, at least in a political context, is there potential for misuse. A story can be told that warps or ignores reality.

Consider the stories told about the failure about the Affordable Care Act. Yes, there are problems with the law, serious issues that should be explored, and, if possible fixed. But at the same time, every cancellation of an insurance policy is not “because” of Obamacare. Stories of millions of cancellations are not possible when only 14 million people have individual health insurance plans. Even before the law, those plans changed often. Cancellations were common. But it didn’t matter as a story because eight-in-ten Americans, before the law and now, get health insurance through their employer. But it’s so easy to use Obamacare as the excuse, covering up problems that existed long before the Affordable Care Act.

So what are the Indian Country’s stories for 2014? The long view stories will continue to unfold. Two years ago, in 2012, there was a successful effort to turn out Indian Country’s voters. Will that narrative come back? Or will history again show that off-year elections are wasted opportunities? Already there’s a projection of a Republican sweep this year from Larry Sabato.

But most of the stories for this year we won’t know until they, using the vernacular of the Internet, “go viral.” A story that’s told that suddenly resonates across Indian Country and beyond. It’s those stories that can be effective in shaping the world as we’d like it to be.

Mark Trahant is the 20th Atwood Chair at the University of Alaska Anchorage. He is a journalist, speaker and Twitter poet and is a member of The Shoshone-Bannock Tribes. Comment on Facebook at: https://www.facebook.com/TrahantReports

Share on Facebook

Trahant

trahant MARK
TRAHANT

 
Austerity

What is “The Canon of Indian Country?”

Those stories that are recited in schools, the ones most young people know by heart, tales of valor, excellence and an optimistic future.

We do have great modern stories to tell.

How leaders like Joe Garry or Lucy Covington out maneuvered Congress and put an end to the nonsense called termination. Or how Taos leaders patiently pressed the United States for the return of the sacred Blue Lake, even though that effort that took nearly seven decades. Or how a summer program in New Mexico helped create an entire generation of American Indian and Alaska Native lawyers.

But there is no canon. So important stories drift about in individual memory, forgotten far too easily, instead of being told again and again.

The story of Forrest Joseph Gerard is one that ought to be required in any Indian Country canon. He died on December 28, 2013, in Albuquerque.

Forrest Gerard was born on Montana’s Blackfeet Reservation on January 15, 1925, on a ranch near the Middle Fork of the Milk River. He told me that his “childhood I had there would have been the envy of any young boy in the United States. We had a horse of our own. We could walk maybe 15 or 20 yards have some of the best trout fishing in northern Montana. We had loving parents. We had love, support and discipline. And this was my universe, this was a world I knew.”

That world he knew changed many times in his early life. During the Great Depression his family moved into the “city” of Browning so his father could take a job. After his high school graduation, Gerard was eager to join the military and enter World War II. He was only 19 on his first bombing mission on a B-24 with the 15th Air Force. “We were forced to face life and death, bravery and fear at a relatively young age. That instilled a little bit of maturity into us that we might not under normal circumstances,” Gerard recalled. The military also opened up access to the G.I. Bill of Rights and a college education, the first in his family to have that opportunity.

After college, Gerard worked at jobs that built his personal portfolio at agencies in Montana and Wyoming until moving to Washington, D.C., in 1957 to work for the newly-created Indian Health Service. Over the next decade or so Gerard took a variety of posts, including a coveted Congressional Fellowship, a post at the Bureau of Indian Affairs and Health and Human Services.

But our story picks up in 1971 when Gerard is hired by Senator Henry Jackson, chairman of the Interior and Insular Affairs, as a professional staff member for Indian affairs. Jackson had long been an advocate for termination and his staff assistant, James Gamble, had carried out that policy with a sense of mission. By hiring Gerard, Jackson was reversing course. (He did not fire Gamble, but moved him on other legislative issues, such as parks.)

To send a signal to Indian Country. Jackson issued a statement calling for a Senate resolution reversing House Concurrent Resolution 108 — the termination proclamation — and the message was delivered to Yakama Chairman Robert Jim while he was on the Hill. “He rushed out of the building, jumped in a cab, went over to where the NTCA was meeting, burst into the room, interrupted who ever was speaking, and told them Jackson was introducing legislation to reverse House Con. 108,” Gerard said. “In that one fell swoop, we did more to reverse Jackson’s image in Indian Country.”

The next step was more substantial. Turning Richard Nixon’s July 1970 message into legislation. That next step was the Indian Self-Determination and Education Assistance Act, eventually signed into law on April 3, 1974.

But the legislative train was running. The self-determination act was followed by the Menominee Restoration Act, the Indian Finance Act, and, what Gerard considered his legislative capstone, the Indian Health Care Improvement Act.

It’s hard, even today, to imagine a string of legislative victories such as what happened during the partnership of Gerard and Jackson. The record speaks for itself.

After leaving the Senate, Gerard worked on Capitol Hill representing tribes until President Jimmy Carter nominated him as the first Assistant Secretary for Indian Affairs in the Interior Department. In that post, he set the standard for the job itself, making certain that policy included voices from Indian Country.

Gerard wrapped up his career in the private sector, again representing tribes in Washington.

So why should Forrest Gerard’s story be in The Canon? Simply this: He traveled from the Blackfeet Reservation in Montana and built a professional career. He was prepared for that moment in time where he was offered a job with enormous potential, shepherding legislation that not only ended termination as a policy, but promoted tribal self-determination as an alternative. Sure, there had been other American Indians working on Capitol Hill, probably just two or three before Gerard, but none were given the authority to act in the name of a full committee chairman and craft law. This was new — and huge.

After he left the committee, Sen. Jackson asked Gerard if he thought the self-determination process would happen all at once, if tribes would contract for the BIA and IHS? “No,” Gerard answered. “There would be steady progress.”

Nearly forty years later that progress continues. Today more money is spent on tribally-operated health care than on Indian Health Service operations. It’s the same at the Bureau of Indian Affairs.

Steady progress by tribal governments. And a story to add to The Canon.

Mark Trahant is the 20th Atwood Chair at the University of Alaska Anchorage. He is a journalist, speaker and Twitter poet and is a member of The Shoshone-Bannock Tribes. The story of Forrest Gerard is told in the book, The Last Great Battle of the Indian Wars. Comment on Facebook at:
https://www.facebook.com/TrahantReports

Share on Facebook

Trahant

trahant MARK
TRAHANT

 
Austerity

Monday was a key deadline for the Affordable Care Act. In order to begin insurance coverage on January 1, 2014, people were supposed to sign up by December 23, 2013, for that shiny new policy.

(On Monday the White House announced the deadline is extended a stay. That’s a good thing for people trying to navigate the web site at the last minute.)

How many American Indians and Alaska Natives signed up for this new program? Who knows? But you’d think that something this important would have so much information posted about that it would almost be annoying. There should be posters, flyers, signup fairs, reminders and banners. This should be a big deal.

Instead this deadline whizzed by, hardly making a sound in Indian Country.

So this is why the deadline, and health insurance, matters.

From this point forward every American Indian and Alaska Native who signs up for some form of insurance, through a tribe or an employer, via Medicaid, or through these new Marketplace Exchanges, adds real money to the Indian health system.

How much funding? Healthcare reform expert Ed Fox estimates the total could exceed $2 billion. But what makes that $2 billion even more important is that it does not need to be appropriated by Congress.

Most of that funding stream will come from the expansion of Medicaid, the primary mechanism for expanding coverage under the Affordable Care Act. This is a particularly thorny problem for Indian Country because only about half of the states with significant American Indian and Alaska Native populations have expanded Medicaid. That’s why it so important for Indian Country to keep pressing for this critical funding source.

But even without the Medicaid expansion, many in Indian Country are eligible for special considerations through the Marketplace exchanges. Most people won’t have to pay out-of-pocket costs like deductibles, copayments, and coinsurance depending on income. And American Indians and Alaska Natives have a sort of permanent open enrollment period, so the signup can occur anytime.

But, as Dr. Fox writes, “Unfortunately, fewer than 10% of those American Indians / Alaska Natives eligible for subsidies will purchase qualified health plans, even fewer American Indians / Alaska Natives likely if they currently receive services at an IHS-funded health program.”

So the problem remains that as long as one-in-three (non-elderly) American Indians and Alaska Natives are uninsured, there will not be enough money to pay for quality healthcare.

But the Affordable Care Act is an alternative. This is the deal: The Indian health system has never been fully funded. And that is not likely to change in our lifetime. No Congress or president in the history of this country has ever presented a budget that meets the health care needs of Indian Country.

But the Affordable Care Act opens up a new way of tapping money, exchanging complexity and paperwork for more money that does not have to go through Congress. Money that can go directly and automatically into the Indian health system. According to the Kaiser Family Foundation, nine in ten American Indians and Alaska Natives qualify for some sort of assistance to get coverage.

The Affordable Care Act’s potential revenue stream is particularly important right now because the appropriations process in Congress is so completely broken.

But. Wait! American Indians and Alaska Natives have a treaty right to health care. There is no need to do anything, right?

Then I was re-reading my tribe’s treaty with the United States, the Fort Bridger Treaty of 1868. Article 10 says: “The United States hereby agrees to furnish annually to the Indians the physician, teachers, carpenter, miller, engineer, farmer, and blacksmith, as herein contemplated, and that such appropriations shall be made, from time to time, on the estimates of the Secretary of the Interior, as will be sufficient to employ such persons.”

And there is that word: “appropriations.” The process that Congress uses to spend money; a framework that has never even once considered full funding for Indian health.

I hear from many folks who say this is all too much. Let’s repeal the law and start over. Ok, then what? Repealing the law is not going to change the dismal funding of the Indian health system. Congress cannot even agree on regular spending, let alone something like that. But for all the complications, for all the confusion about web sites and paperwork, the Affordable Care Act opens up a check book with a couple billion dollars. We can watch deadlines whiz by. or, we can say, there it is. Take it.

Mark Trahant is the 20th Atwood Chair at the University of Alaska Anchorage. He is a journalist, speaker and Twitter poet and is a member of The Shoshone-Bannock Tribes. Join the discussion about austerity. Comment on Facebook at:
https://www.facebook.com/TrahantReports

Share on Facebook

Trahant

trahant MARK
TRAHANT

 
Austerity

The healthcare.gov web site is working. I spent some time on it this weekend and it was easy to navigate, pages popped up when they should, and I quickly found answers.

All of this is good news because it will make it easier for folks to fill out the forms and see what’s possible under the Affordable Care Act. If you want insurance to begin on January 1, 2014, then you need to fill these forms out this month. The deadline is December 23.

But for American Indians and Alaska Natives this process is both confusing and damning. It’s confusing because it’s a form that requires financial information, a lot like a tax return, so it means rounding up some documents. The damning part? I’ll get to that shortly. First let’s explore the healthcare.gov process.

For American Indians and Alaska Natives: The most important form is “Appendix B.” This is the paperwork that secures a lifetime exemption from the insurance mandate. Lifetime is a pretty good deal. So paperwork or not, this is worth doing this month (or you can also file this with your tax returns in April).

There is help to fill out these forms. Go to the Indian Health Service or a local urban or tribal clinic. Find someone there who has been trained. You should get answers, because, as IHS acting director Yvette Roubideaux wrote recently, “I don’t know is not an acceptable answer.”

One of the best things I read this weekend was an item in Montana’s Char-Koosta News with a schedule of community meetings on the Affordable Care Act. Yes! This should be happening across Indian Country.

There needs to be information, not just cheerleading, about what this law means and how it might change the Indian health system. (This is the main reason for my five-part video series with Vision Maker Media .) The law will shake up the Indian health system dramatically, opening up new funding sources, as well as presenting new challenges.

The problem is that so much of the discourse has been cast in absolute terms. Democrats need to recognize that this law, like the web site, is not perfect. It’s just one step — and a complicated one at that. And Republicans would better serve the country if they would stop crying repeal and look for constructive additions or subtractions.

Then it’s the same in Indian Country.

I often hear from people who say that Obamacare should not apply. American Indians and Alaska Natives have a treaty right to health care and therefore insurance is not needed. I agree. But then what? It’s a hard fact that Congress is not going to fund the Indian health system as it should. So the only two options are to use this law to expand resources or to watch the Indian health system decline every year as funding shrinks.

There are real problems with this law — and that’s what we should focus on.

Indian Country has a huge stake in the expansion of Medicaid. This is money that will directly improve the Indian health system. It’s funding that does not require appropriation from Congress. But states need to make the decision to opt in — and too many are saying no. Indian Country needs to make sure that the legislators and governors know what this means to their constituents who rely on the Indian health system. (I still think the ultimate solution is to label Indian Country as a 51st state for Medicaid purposes.)

Another concern of mine is that in some cases, individuals will have to purchase the insurance, paying real money, to get a tax credit down the road. On paper that looks like an easy call. But to a family that’s looking at a long list of monthly bills, then one for insurance, even if it’s “free” later is one that might be skipped.

Or, how do tribes pay for insurance as employers for part-time or seasonal employees? It’s a new expense that might not work in a budget environment that is already under pressure because of shrinking federal contracts. Tribes will have do one of three things: Hire fewer people, pay a fine, or come up with the money to buy insurance.

The healthcare.gov web site may work perfect today. But there still is a lot of fine tuning ahead when it comes to the Affordable Care Act. Especially for Indian Country.

Mark Trahant is the 20th Atwood Chair at the University of Alaska Anchorage. He is a journalist, speaker and Twitter poet and is a member of The Shoshone-Bannock Tribes. Join the discussion on Facebook at: https://www.facebook.com/TrahantReports

Share on Facebook

Trahant

trahant MARK
TRAHANT

 
Austerity

The United States Senate is a curious institution. It’s not democratic. It’s not representative. And it’s the ultimate millionaire’s sandbox.

So in the U.S. constitutional scheme: The 38 million people living in California get two votes out of 100, the same as the 576,000 folks who are residents of Wyoming.

One person’s vote is worth more if they live in a tiny state, but at least it’s a vote. Because some four million American Indians and Alaska Natives — citizens of tribal governments — aren’t counted as a unique constituency. By land mass, Indian Country’s 50-plus million acres are bigger than almost half the states. Even breaking that number up into population counts, Cherokee’s 819,000 people or Navajo’s 350,000 is in the same ballpark as one of those small states.

But that’s the deal. And the Constitution is sacred script (roll the organ-heavy musical theme now). So get over it, right?

But the thing is the U.S. Senate, this undemocratic institution, is made worse by the filibuster. Especially now that the filibuster has become a routine, invoked on every nominee or every bill. Instead of fifty votes, a supermajority of 60 votes, was required to get anything done. That changed last week. Senate Majority Leader Harry Reid, D-Nevada, used another rule (one requiring just 50 votes) to overrule the filibuster on judicial and executive nominees. Only now that that procedure has been invoked, it’s only a matter of time before the filibuster is gone forever. (The filibuster is only a tradition, not a constitutional procedure. It’s only been used for about a century. And in the past decade it’s use has increased significantly.)

Let’s be clear: The super-majority has not been good for Indian Country. One of the reasons it took so long to pass the reauthorization of the Violence Against Women Act was that 60-vote hurdle. Or reach a final settlement on the Cobell lawsuit. Or we’ve been reading all about the complications with the Affordable Care Act. One of the key appointments, Donald Berwick, was never confirmed as the director of the Centers for Medicare and Medicaid, and took the job with a limited timeframe as a recess appointment.

A filibuster-free Senate could also make it easier for American Indians and Alaska Natives to get appointed as federal judges.

This is one of those areas where the under-representation is beyond acceptable.

A current judicial nominee, Former Arizona U.S. Attorney Diane Humetewa, a Hopi, should have an easy confirmation, and this new rule means one less hurdle. If confirmed, she will be the only Native American as an Article III judge (representing the judicial branch of government). It’s a lifetime gig.

But over the past couple of decades the entire Senate confirmation process, not just the filibuster has been an obstacle. The National Congress of American Indians and the Native American Rights Fund have been working on an education project to “ensure that American Indians and Alaska Natives receive fair consideration for federal vacancies.” Right now there are 93 openings for judges.

When Arvo Mikkanen, who is Cheyenne and Kiowa, was appointed as a federal judge in Oklahoma in 2010, the state’s two senators, Tom Coburn and James Inhofe, went out of their way to keep him off the bench.

Mikkanen, writing in The Atlantic, asked Coburn, “what exactly do you think you know about me that disqualifies me for a spot on the bench? The implication of your quote last week — “I know plenty. I have no comment” — implies that you believe you have some non-public information that would cast a negative pall upon my nomination. So what is it? As a dedicated public servant, someone who has worked in the federal government longer than you have, I believe I am entitled to that answer; and then to be free of the dark insinuation your comment suggests.”

Not a word from Coburn. Nothing from Inhofe. And no hearing either. The nomination was eventually returned from the Senate to the White House without action. No filibuster. Not even a vote.

But the threat of a filibuster as well as the traditional deference to the state’s senators was enough to keep Mikkanen off the bench.

This is absurd. And it’s why the filibuster’s death should be celebrated.

Mark Trahant is the 20th Atwood Chair at the University of Alaska Anchorage. He is a journalist, speaker and Twitter poet and is a member of The Shoshone-Bannock Tribes. Join the discussion about austerity. Comment on Facebook at:
https://www.facebook.com/IndianCountryAusterity

Share on Facebook

Trahant

trahant MARK
TRAHANT

 
Austerity

Modern U.S. presidents have a curious relationship with North America’s first residents, American Indians and Alaska Natives.

President Richard Nixon in July of 1970 sent a special message to Congress calling for a new era with the indigenous tribes because “on virtually every scale of measurement — employment, income, education, health — the condition of the Indian people ranks at the bottom.” Nixon called for a “new era in which the Indian future is determined by Indian acts and Indian decisions.”

Not every president got the memo.

President Ronald Reagan, for example, found himself in Moscow confused by the entire premise of federal-Indian relations. “Let me tell you just a little something about the American Indian in our land,” he told a group of students in the former Soviet Union. “We have provided millions of acres of land for what are called preservations—or reservations, I should say. They, from the beginning, announced that they wanted to maintain their way of life, as they had always lived there in the desert and the plains and so forth. And we set up these reservations so they could, and have a Bureau of Indian Affairs to help take care of them. At the same time, we provide education for them—schools on the reservations. And they’re free also to leave the reservations and be American citizens among the rest of us, and many do. Some still prefer, however, that way—that early way of life. And we’ve done everything we can to meet their demands as to how they want to live. Maybe we made a mistake. Maybe we should not have humored them in that wanting to stay in that kind of primitive lifestyle. Maybe we should have said, no, come join us; be citizens along with the rest of us.”

Reagan’s idea was insulting to the five hundred tribal governments that existed before the United States. These tribal government survived conquest and exist today because the United States negotiated treaties with them for lands and other concessions. Those treaties promised doctors and hospitals, schools, and other basic governmental services.

That history sets the stage for Barack Obama.

As president he has announced no new sweeping policy initiatives — how do you trump self-determination? Yet most of his policies have been generally supportive of tribal governments. At the 5th White House Tribal Nations Conference (held at the Interior Department because the largest room at the White House — the East Room — is too small for such a gathering) Obama promised to make his first “state” visit to Indian Country as president.

Before the president arrived, Secretary of the Interior Sally Jewell told tribal leaders that she heard from them “over and over and over again that sequestration is killing us.”

One tribal leader said a few minutes later: “We need your help with sequestration. We did not create the federal debt … Treaties are not discretionary.”

But Congress, not the president, decides what’s discretionary. So even a supportive president is limited by austerity.

“We’ve got to stop the self-inflicted wounds in Washington,” the president said. “Because for many tribal nations, this year’s harmful sequester cuts and last month’s government shutdown made a tough situation worse. Your schools, your police departments, child welfare offices are all feeling the squeeze. That’s why I’m fighting for a responsible budget that invests in the things that we need in order to grow -– things like education, and job training, and affordable housing and transportation, including for Native American communities.”

Treaties are the ultimate promise, a constitutional promise by one government to another. But that framework collapses when Congress refuses to go along. President Obama may be the head of state, but the word of that state is dependent on a Congress that cannot even agree on how to even write a budget.

So the president stuck to a politician’s litany, ticking off what he considers success stories. “We’ve created jobs building new roads and high-speed Internet to connect more of your communities to the broader economy,” the president said. “We’ve made major investments in job training and tribal colleges and universities. But the fact remains Native Americans face poverty rates that are higher by far than the national average. And that’s more than a statistic, that’s a moral call to action. We’ve got to do better.”

It’s true that President Obama’s budgets have added investment dollars to American Indian and Alaska Native communities. But since Congress has been operating without budget, there has not been more resources available for the past couple of years. And last year the process of sequester made the situation even worse because of across the board budget cuts.

Consider Native American health programs. More than half of the Indian health system is now operated by tribes and tribal organizations, but the funding comes from the federal government. Only it’s not enough money to do the job.

The Affordable Care Act is supposed to change that by encouraging American Indians to sign up for benefits under a variety of insurance schemes, ideally adding money into Indian health. President Obama put it this way, “we’ve got to keep our covenant strong by making sure Native Americans have access to quality, affordable health care just like everybody else.”

That’s it. American Indians and Alaska Natives are supposed to have a treaty right — a special right — to health care. One that’s fully-funded. It’s not “affordable health care just like everybody else.”

The Obama stump speech, in its own way, is no more enlightening than Reagan when he says “for Native Americans, this means more access to comprehensive, affordable coverage.”

Affordable coverage is not the same as pre-paid, treaty-based health care.

Then, treaty or not, there is a case to be made why American Indians and Alaska Natives should be included in the Affordable Care Act plans, especially Medicaid and even through the state-based exchanges. The problem is that the president did not make that case.

—-

Mark Trahant is the 20th Atwood Chair at the University of Alaska Anchorage. He is a journalist, speaker and Twitter poet and is a member of The Shoshone-Bannock Tribes. He has a new web series on Native Americans and Obamacare. ( A version of this column appeared on Al Jazeera English.)

Share on Facebook

Trahant

trahant MARK
TRAHANT

 
Austerity

There has been much controversy about the Affordable Care Act, what some call Obamacare. The politics are beyond intense. And those computer glitches are making it virtually impossible for people to enroll.

But for American Indians and Alaska Natives there is a whole different story to tell about the Affordable Care Act. Native Americans have a right to health care. This is a deal the United States made, a promise that including sending doctors to the tribes that signed treaties in exchange for peace and for titles to lands.

Promise or not, treaty or not, the entire history of healthcare in Indian Country has been defined by shortages. There has never been enough money to carry out that sacred bargain.

The modern Indian Health Service was created in 1955. And over the following decades, more clinics were built, more doctors were hired, and health care for Native people improved. Still, the agency never had enough money.

In 1965 when Medicare and Medicaid were enacted into law there wasn’t even consideration about how these programs would impact American Indians and Alaska Natives. The Indian Health Service could not bill the agencies for serving eligible services. Native Americans were essentially left out of that health care reform effort.

That history of shortages is critical context to understanding the Affordable Care Act. Because from the very beginning of the legislative process, the Affordable Care Act included Indian Country. This happened because a decision was made by tribal leaders to roll the Indian Health Care Improvement Act into the larger legislation.

“Let me tell you why it was different this time,” said Jacqueline Pata, executive director of the National Congress of American Indians. For nearly twenty years tribes urged Congress to reauthorize the Indian Health Care Improvement Act. Then the discussion began about a health care reform.

“We were sitting at an NCAI board meeting, tribal leaders around the table, and said we really have to engage in this health care debate this time around. There were those that said, “no, let’s stay where we are,’” she said. But former NCAI President Jefferson Keel knew the health care industry and he agreed with the broader approach. “So we immediately started to look at the overall health care bill, working with the members of Congress, to be able to find all those other places that it was important to insert ‘and tribes.’ So not only did we get Indian Health Care (Improvement Act) reauthorized permanently. But we were able to get provisions into Medicaid, we were able to get the tax exemption (for tribes that purchase insurance for members), we were able to include a lot of places where tribes should have been considered but probably wouldn’t have been if we didn’t integrate those two pieces of legislation.”

But there still is a question of why? Why American Indians and Alaska Natives need insurance of any kind when there is a treaty right, a statutory call to healthcare, that transcends this latest national experiment? Then recall the long history of shortages. The Indian health system has never been adequately funded, probably less than half of the appropriation that would bring about some sort of parity with other federal health systems.

The main idea in the Affordable Care Act is to require health insurance for all Americans because that lowers the cost for everyone, the so-called “mandate.” But American Indians are exempt from that mandate (even if the Indian health system does not count as insurance). So the way that exemption works, this year at least, is that American Indians and Alaska Natives will have to fill out forms for an exemption (once granted, it’s a lifetime deal). The good news here is that the whole website mess does not apply.

Then insurance itself is a complicated idea for Indian Country. What is called “third party billing” has been a small, but growing part of the financial resources for the Indian health system.

You see there is this odd American idea that links health insurance to our jobs. That’s how most Americans now get their health care — and will continue to do so even under the Affordable Care Act. But that one element is a big difference for Indian Country. Only 36 percent of American Indians and Alaska Natives have insurance purchased through work — that’s half the rate for most Americans — and 30 percent of us have no insurance at all.

But the Affordable Care Act is designed to change that. The new law offers incentives for people to get health insurance coverage at a reduced rate or even free. So why would American Indians and Alaska Natives purchase insurance?

“The Indian health system is only funded at about fifty percent,” said Valerie Davidson, senior director of legal and intergovernmental affairs at the Alaska Native Tribal Health Consortium in Anchorage. “Anybody who’s ever been to a tribally-operated program or an urban program or an IHS facility, they know the services are limited. Unfortunately there isn’t enough funding. And so we rely on those third-party reimbursements (or insurance) to make those ends meet, to be able to keep the clinic’s lights on.”

She said the Affordable Care Act is an opportunity to make sure that American Indians and Alaska Natives have additional health care coverage. “So the things that the Indian Health Service funding typically doesn’t pay for is medically-necessary travel (unless it’s considered life or limb). So generally an emergency is taken care of,” Davidson said. “But it may not cover routine travel.” She said an example would be people who live in a community without a dentist — so the only available option requires travel. “Having that extra coverage could cover the medically-necessary travel,” she said.

Insurance that covers medical travel is one reason for individuals to purchase insurance — and there are other reasons as well. A diabetes patient who’s insured would get better care, more access to the wider selection of procedures and drugs.

But the problem is that the rules for the insurance marketplaces are doubly complicated for Indian Country. Who’s eligible? How much? And, just what are the rules?

Indian Health Service Director Yvette Roubideaux said answers will be found in every clinic, where you get your care now. “I don’t know,” she said, “is not an acceptable answer.”

But if the law is to be successful in Indian Country there has to be a greater effort at educating people about their options. The Government Accountability Office recently said it will take a major campaign to make that so. That means hiring more people, lots of people, to help Native Americans navigate through this maze.

But there are already models for this kind of campaign. The Census was effective with “Indian Country Counts.” And, as NCAI’s Pata points out, last year’s efforts to register Native American voters is the kind of operation that’s needed. “It’s so critically important that tribes get engaged in giving direction. Tribes need to think about this the way they would with their Native Vote campaign,” she said. “They need to be able to have sign-up fairs, where they can actually answer the questions.”

So will American Indians and Alaska Natives sign up for insurance? If that happens it won’t because of a working web site in Washington, D.C. It will happen because every clinic in the Indian health system explains to patients why insurance matters and how it means more money for all.

The most important insurance program for American Indians and Alaska Natives is Medicaid.

When the Supreme Court upheld the Affordable Care Act, the headline was that the majority affirmed the individual mandate. But the second part of that decision is that the United States could not force all 50 states to expand Medicaid coverage.

Medicaid is a particularly complex government insurance program for the poor. But what makes Medicaid so important is that its funding source is not appropriated by Congress. It’s an entitlement. If a person is eligible, then the money is there. Automatically.
Medicaid is also a partnership between a state government and the federal government.

But for American Indians and Alaska Natives, it’s an odd marriage. The federal government picks up 100 percent of the cost. But even though the bills are paid for by Washington, each state sets the rules for eligibility about who and what will be covered.

The result is that about half of Indian Country will be covered by states where Medicaid is expanding — and the other half live in states that have said no. This means that hundreds of thousands of American Indians and Alaska Natives will lose out on expanded insurance coverage that the Affordable Care Act was designed for.

So this means that the Indian health system will essentially be split in two. There will be more money for health care in states where Medicaid expands — and less in the states that have said no. In the “no” states that will be even less money for an already underfunded Indian health system.

Watch North Dakota and Arizona. Two conservative, red states, looked at their numbers — and especially their Native American population — have already decided to expand Medicaid. If the program works in those two states, then other states with large native populations, might join the party. But if not, there is always the possibility that Indian Country could be treated as a 51st state. (The Affordable Care Act even begins that consideration by allowing a beta test of sorts for the Navajo Nation.)

The numbers are huge. The GAO says: “Excluding those already enrolled, potential new enrollment in Medicaid could exceed 650,000 out of 2.4 million (27 percent) for those identifying as American Indians and Alaska Natives alone, and almost 1.2 million out of 4.8 million (25 percent) for those identifying as American Indians and Alaska Natives alone or in combination with another race.”

NCAI’s Pata says the Affordable Care Act also “makes it really important for tribes, as they look at their health care clinics, to think of them as businesses. And not just as businesses for their tribal members, but businesses for their community, particularly the smaller tribes.”

The flip side of that idea is a shift in power from the clinic to the individual. Once someone has insurance, either through Medicaid, the marketplace exchanges, or another program, then that person might not choose to remain in the Indian health system.

“That’s the other reason why tribes need to think of (clinics) as businesses,” Pata said.

In some ways the urban Indian clinics are ahead of the Affordable Care Act. Because so little IHS funding — about one percent — goes to urban clinics, they have had to act like business enterprises.

“The greatest challenge is balancing the historical manner in which we have provided services, which have been geared around the needs of the population, with the growing demand for reaching out to other communities to get sufficient volumes to get the revenues to keep the doors open,” said Ralph Forquera, executive director of the Seattle Indian Health Board. “That balance of natives to non-natives … has always been a complex thing to manage. Some clinics around the country have seen a dramatic drop-off in their Indian participation in their clinics because the economics just don’t work. They need to go out and seek non-native people and enroll them in their programs to keep the doors open.”

He adds that Seattle has been fortunate because it’s been able preserve that balance.

But Seattle has a larger population base, something that is not true in all communities.

“It does change the dynamic,” Forquera said. “Those are some huge challenges but they are not unique to us. The tribal community clinics may be in even more challenging situation if the dynamic changes.”

He said one thing to watch is a shift away from fee-for-service payments to clinics to a more managed-care approach. For managed care to work, there has to be a larger scale, more people. “In order to be able to work in that kind of environment, you have to enroll large numbers of individuals in order to generate the revenues to pay for staff and the facilities, all the things necessary to provide the services” Forquera said. That concept could make it more difficult for Indian programs with small numbers of people.

But the Indian health system does have one huge advantage over the larger health system — and that’s underfunding. Underfunding as an opportunity? Yes. Because it’s already led to smarter, more efficient ways of operating. It’s made innovation possible.

Alaska’s dental health therapist program is a great example of that kind of thinking. “We recognized that we’re not going to be able to have a dentist in every community,” said Davidson. “So we developed a two-year training program to be able to train people to provide mid-level oral health care. Most of their work is in prevention, but they can also do exams, develop treatment plans, they can do fillings, and simple extractions.”

The payoff? “The tribal health system has been innovative by necessity. And a lot of these programs can and have served as models for the rest of the United States,” Davidson said. “Tribes have shown time and time again that we are a really good investment. We can do more with less. If you take a look at what we are able to do today, compared with what we were able to do before we were able to assume ownership of our own system, the difference is tremendous. We can take innovation to a whole different level.”

So will the Affordable Care Act work?

It’s too early to know that answer. But this is not new in history. More than sixty years ago the Bureau of Indian Affairs ran health care programs. It was awful. One doctor wrote: All we really need are good doctors, facilities and pharmaceuticals. I am weary.” Congress finally got the message in 1955 and created the Indian Health Service. But that shift — as dramatic as the one today — worked and it significantly improved the quality of life for American Indians and Alaska Natives.


Mark Trahant is the 20th Atwood Chair at the University of Alaska Anchorage. He is a journalist, speaker and Twitter poet and is a member of The Shoshone-Bannock Tribes.

Share on Facebook

Trahant

trahant MARK
TRAHANT

 
Austerity

The Fiscal Yahoo Caucus of the United States Congress is ready to reach into your family wallet and grab cash. Need to buy or refinance a house? Ca-ching. Owe anything on credit cards, perhaps a revolving business loan, or need student loans? Ca-ching. Ca-ching. Ca-ching.

This nonsense — a refusal to raise the federal debt limit without all sorts of conditions — matters to everyone because we as Americans borrow money at extraordinary low rates. We borrow a lot of money, actually, so even a small increase in interest rates could really hurt.

The General Accountability Office says: “Spending on net interest as a percentage of federal spending has fluctuated over time, peaking in the late 1940s and in the mid 1990s. In the past, interest payments contributed to deficits and helped fuel a rising debt burden. Rising debt, in turn, raised interest costs in the budget, and the federal government increased debt held by the public to finance these interest payments. This has been called the ‘vicious cycle.’ Today’s relatively lower interest rates have lessened the pressure debt service places on the budget, despite the recent increase in the debt held by the public.”

We have a good deal. Interest payments as a percentage of the total economy were at 14.6 percent in 1948; today that number is only 6.4 percent.

So what if interest payments were that high again? The wheels of government come off.

Remember that government debt is financed in public markets. That debt is sold at auction, so someone has to be a “buyer” of bonds. “Consequently, the amount that the federal government spends for interest on its debt is directly tied to those interest rates,” the GAO said. “Under CBO’s January 2012 baseline budget projections, debt held by the public would be 62 percent of GDP in 2022 and spending on net interest would rise from $227 billion in 2011 to $624 billion (or 2.5 percent of GDP) in 2022. CBO has assessed how changes in interest rates can affect federal spending. CBO notes that if interest rates are 1 percent higher than the rates assumed in CBO’s baseline budget projections, the government’s higher interest costs would add nearly $1 trillion to the cumulative budget deficit over the 10-year period.”

The Congressional Budget Office in a 2010 paper on the prospect of debt-driven crisis wrote: “Fiscal crises around the world have often begun during recessions and, in turn, have often exacerbated them.”

If investors lose confidence (and even slow down the purchase of bonds) then interest rates could climb sharply. (The Congressional Budget Office in a May report said an interest rate increase would be “minimal in 2013 but substantial over the coming decade.” CBO scored the cost from $1.4 trillion to $6.3 trillion higher.)

The result is that interest payments then crowd out other spending, the cycle of austerity.

And all of this is just government. The cost of U.S. debt is the benchmark for everything else. So loans for houses, credit cards, tribal enterprises, cars, you name it, would also rise. Think of it as a massive tax increase, a gift that keeps on giving (only the money goes to investors – not government.)

There is even worse news in this scenario for federal programs that serve American Indians and Alaska Natives. Because the budget would go up to pay more interest, there would be less money for everything else. All federal budgets would be cut drastically. Sequestration would look like the good old days.

Perhaps the Fiscal Yahoo Caucus or even House leadership will come to its senses before this all happens. We can only hope so. Anything short of that would require replacing the words, “Fiscal Yahoo,” with a profanity phrase that uses the same “F” and “Y” letters. Ca-ching.

Mark Trahant is the 20th Atwood Chair at the University of Alaska Anchorage. He is a journalist, speaker and Twitter poet and is a member of The Shoshone-Bannock Tribes. Join the discussion about austerity. Comment on Facebook at:
https://www.facebook.com/IndianCountryAusterity

Share on Facebook

Trahant

trahant MARK
TRAHANT

 
Austerity

Watch out for fights coming from the Capitol. The Senate versus the House. Republicans opposed to Democrats. And, of course, the most intense battle, Republicans against Republicans.

I grew up with the Spy versus Spy comics from Mad Magazine. Week after week a white clad spy would deliver some sort of lethal device (think exploding toilets) to a black suited spy. The scenarios were always outlandish and neither character ever really won. It’s that way in DC right now, except most of spies in combat are wearing Republican Red.

The Spy versus SpySpy versus Spy battle is alive and well on Twitter where there’s a #dontblink campaign to try and convince those squishes to support the filibuster. It’s not going to happen, but it does increase the possibility of a government shutdown simply because Congress is running out of time to meet the October 1st deadline. (The Senate has rules about how much time is allowed for a debate after cloture.) That means any vote for a temporary budget to fund the government cannot occur until the end of the week, Friday or Saturday. Then it will go back to the House. Perhaps with changes. Senate Majority Leader Harry Reid will send a “clean” resolution to the House, hoping that body will pass it without changes just to keep the doors open. But probably not. Then the process will start again — with the government officially closed. (On Tuesday, Senator Reid announced the measure will only fund the government until Nov. 15, leaving open the possibility of a regular order budget.)

This is as goofy as Spy versus Spy. And just like the comic strip, there’s no real winner in sight. The games just go on and on.

There is a bigger problem for Indian Country, however. Actually two issues. First, any “resolution” of this crisis is completely temporary. The same debate will surface again over the debt limit in a couple of weeks and then again when this Continuing Resolution expires. The House bill only pays for government operations until December 15. So, even if the Senate’s shorter version passes, the whole mess will repeat.

The second issue is that neither the House nor the Senate are ready to remove the sequester from the spending bill. That means that the budget will continue to shrink for the federal government — and tribes, schools, clinics, any agency that relies on appropriations.

Ideally the House would have sent over its budget bill — and then the Senate would have added dollars to key programs, such as those that benefit Indian Country, and negotiations would have begun. But the focus on the Affordable Care Act has made time the enemy. In order to avoid a shutdown, the Senate’s leadership is trying to send back to the House a bill that might quickly pass.

The sequester has reduced federal spending for domestic programs by 17.8 percent compared to 2010 levels (including adjustments for inflation), according to the Center for Budget and Policy Priorities. That means the sequestration cuts in 2014 will total $109 billion, ] evenly split between defense and non-defense programs. Congress should not ignore the significant funding gaps in critical public services on the non-defense side of the discretionary budget,” say authors Joel Friedman, Richard Kogan, and Sharon Parrott. “Congress should replace sequestration with a sound package of balanced deficit-reduction measures that take effect as the economy strengthens.”

But debate is not even occurring; the entire conversation is about the Affordable Care Act and what it will take for Congress to keep the doors open.

This past spring, the National Congress of American Indians said Congress should find a way to hold Indian Country harmless from this round of budget cuts. “The sequester cuts pose particular hardship for Indian Country and the surrounding communities who rely on tribes as employers, where the recession struck especially hard,” said the report, A Call to Honor the Promises To Tribal Nations in the Federal Budget. “Tribal leaders urge Congress to protect the federal funding that fulfills the trust responsibility to tribes in the face of difficult choices.”

The list of programs impacted by the sequester are in every corner of Indian Country, on reservations, in Alaska villages, and in urban centers. It ranges from health care delivery to education at all levels, representing a basic federal investment in the future (and in fulfilling solemn promises).

But the sequester isn’t even being debated. Congress is too busy playing Spy versus Spy.

Share on Facebook

Trahant