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Posts published in “Trahant”

Presidents on the res

trahant MARK
TRAHANT

 
Austerity

The Associated Press, MSNBC and other news media are sticking to the story that Obama is only the fourth president to visit a reservation. I say at least seven, more likely eight.

So one by one here goes the documentary evidence (for those who care).

President Chester Arthur's visit to Wind River, Wyoming, 1883. Picture from Frank Jay Haynes collection, Smithsonian. The trip was on horse back and included a senator and the Secretary of War. (I love the umbrellas in the picture above.)

The second visit is President Warren Harding’s trip to Alaska in 1923. The first port of call was Metlakatla. (As Stephen Conn points out: Any presidential visit before the Alaska Native Claims Settlement Act would be a visit to Indian Country.)

Third. President Calvin Coolidge’s visit to South Dakota.

A trivia question: How many US Presidents have been photographed wearing headdresses? (It went badly for Coolidge.) Answer: At least one, Jimmy Carter.

Fourth. Franklin Roosevelt visited at least three reservations, only once speaking on Indian Affairs. He traveled to Quinault in Washington state, Blackfeet, Montana, and Cherokee, North Carolina. (He was also photographed with a chief in North Dakota.)

Here is a film from the Montana trip. (The meeting was in Glacier National Park, but he traveled from the town now called East Glacier.) (more…)

Spending on waste or investment?

trahant MARK
TRAHANT

 
Austerity

All you need to know about the November election is found in dueling documents: Paul Ryan’s budget and the House Democratic alternative. One is down, the other up. One “cuts wasteful spending,” while the other proposes investing in the future. Two radically different approaches to governing.

The Republican plan is in a hurry to balance the budget — slashing federal agency spending so that in a decade from now the budget will be balanced. These cuts would impact low-income populations, such as American Indians and Alaska Natives. Deeply.

And the Democrats’ budget is smart in the short-term — we do need investment now — but it fails to account for spending over a longer time frame. It leaves the answers to some big questions for a later date.

Then, truth be told, neither plan is designed for the long haul.

The United States (and much of the globe for that matter) is facing a demographic imbalance of a rising number of older people. Every day, for the next twenty years, some 10,000 people are turning 65. Think about adding that many people every day added to the rolls of Social Security and Medicare.

The good news is that Social Security is the easiest to fix, adjusting age and benefits, could make the plan solvent for the next generation.

But Medicare is wrapped in a bigger problem: the cost of health care in America.

A graphic from the Congressional Budget Office explains this well by breaking federal spending into four distinct categories: Social Security (growing); Interest on the debt (growing); all other federal spending (shrinking dramatically) and health care (growing faster than everything else). Or, as the CBO describes the problem, “Federal spending for the major health care programs and Social Security would increase to a total of 14 percent of GDP by 2038, twice the 7 percent average of the past 40 years.” (more…)

Transparency and the ACA

trahant MARK
TRAHANT

 
Austerity

The Affordable Care Act is a grand promise. Basically it’s a complicated insurance mechanism that’s designed to reduce the number of uninsured Americans, including those who rely on the Indian health system.

But one thing the ACA is not: Transparent.

This is a critical flaw because we are near another major deadline — March 31 — and some six months into the Act’s implementation and there is not one official scrap of information reporting how well Indian Country is being served. We don’t know how many folks across the country have signed up for Medicaid or how many have purchased insurance or how many individuals have policies that were purchased by tribes as sponsors.

Why does this matter? Because policy is being implemented on assumptions, not data. We don’t know what we don’t know.

This we do know: March 31 is an odd deadline. It’s the day when open enrollment ends for most Americans, including Native Americans who are not tribal members. But that deadline does not apply to American Indians and Alaska Natives who are tribal members. Then a monthly enrollment is possible. (I know, confusing, right?)

Native Americans still can receive a life-time exemption from the insurance mandate. Fill out a simple form and mail to get a certificate that could be included in your next tax return.

But we also know that the individual exemption is not enough. The Indian health system is underfunded and third-party billing — money from private insurance, Medicaid, Medicare, and other programs — is the only way funding will improve. Like it or not, Treaty or not, the Congress is not going to pay for Indian health through appropriations. The $6 billion budget for the Indian Health Service shows the agency collecting more than a billion dollars from Medicaid and only $90,307,000 from private insurance. So there is a lot of room for growth. Again, if folks sign up, the Affordable Care Act is a different course from appropriations; it’s a money stream that’s automatic.

We also know that Indian Country has some of the highest uninsured rates in the nation, roughly one in three people. So every new insured American Indian and Alaska Native adds resources to the Indian health system (and especially medical care that is purchased outside of Indian health facilities).

This week there is a last minute push to get people in Indian Country to sign up. On Monday there was a national Tribal Day of Action sponsored by the White House. And in Montana, the state’s Insurance Commissioner, Monica J. Lindeen, has been traveling to the state’s reservations and urban Indian centers to sell the plan.

But it’s hard to know how well those efforts are working. There are too many questions: How many people signed up early? What’s the goal? Where is the transparency?

Early Affordable Care Act numbers are found in Washington state. Ed Fox, who directs health services for Port Gamble S’Klallam Tribe of Washington, said the Washington Health Care Authority released preliminary figures to tribes for consultation. These are early numbers and will change, but they are an open important look in a state where the Affordable Care Act is working.

Some key findings: Washington probably ranks first in the nation in Medicaid “take-up” for the newly eligible. Some 6,000 or so of the newly insured Native Americans were enrolled by urban programs or tribes, and one-third with state worker assistance, and one-third a bit uncertain (possibly by someone with assistance or on their own). Washington also shows some 7,000 Medicaid re-certifications. (more…)

Keys to the Senate: AK, SD, MT

trahant MARK
TRAHANT

 
Austerity

Is it a foregone conclusion that the Senate will go Republican in November? That’s the talk coming from many strategists in both parties lately.

On Fox News Sunday, Karl Rove said it’s “highly likely” that the Republicans take power. He said seven seats could shift to the GOP control in November, Alaska, Arkansas, Louisiana, Montana, South Dakota, North Carolina and West Virginia. That’s one more than the Republicans need.

Former White House press secretary Robert Gibbs, on NBC’s Meet the Press, is saying something similar. “There’s a real, real danger that the Democrats could suffer big losses,” he said. (Current White House officials are saying — as they should — that Democrats will hang to the Senate.)

What’s pushing this speculation is a special election last week in Florida. It’s not that Democrats lost (it was a Republican seat, anyway). It’s that Democrats didn’t turn out. If that happens again in November, then Republicans win easily.

One of the states in play, Montana, is a good example of the problem.

There are a higher percentage of American Indian voters in Montana than in any other state except New Mexico, a registration that tops 64 percent (a slightly higher percentage than white voters in Montana). This made a difference two years ago when Sen. Jon Tester and State Superintendent of Public Instruction Denise Juneau both won re-election. But two years before that, those same voters disappeared. Conservative candidates won easily.

So is 2014 more like 2012 or 2010? Will Native American voters show up?

Montana is raising questions for other reasons, too. Senate candidate Steve Daines, a member of the House, has visited the state’s reservations and is making his case with tribal leaders.

There is also a difference of opinion in Montana over strategy. As Stephanie Woodard wrote in Indian Country Today Media Network, a voter access organization, Four Directions, blames Democrats for not expanding satellite balloting on the reservation.

The good news is that it’s early. There are months ahead to sort out a Native vote strategy and engage voters. But right now, Montana Senate race is looking like a pick up opportunity for the Republicans.

“If we lose the Senate,” Gibbs said, “turn out the lights. The party’s over.” The final two years of the Obama presidency will be one of defense, limiting the damage, instead of promoting any sort of agenda of growth.

For Indian Country that means more budgets cuts, GOP leadership for the Senate Select Committee on Indian Affairs, and more whittling away of the Affordable Care Act. (more…)

Improving quality, cutting costs

trahant MARK
TRAHANT

 
Austerity

The challenge in health care can be boiled down to two ideas: Improve the quality and cut the costs.

It’s a fact that the U.S. spends too much, both private and government money, on health care, nearly nearly 18 percent of all goods and services. The good news is that cost has been slowing, partly because of the economy, and most partly because the Affordable Care Act.

But this is just a first step. We have a long way to go. The reason is the country’s demographics: We have smaller population of young people, a huge baby boom generation, and people are living longer. Add this all up and the numbers are not sustainable by any metric. So math, not politics, ought to determine the route forward and that means looking for innovation to make health care less expensive. So when something comes along that does just that, you would think that it would be worth a celebration. But that’s not how change works.

As I have written before, the Alaska Native Tribal Health Consortium’s Dental Health Therapist Program is such a model. The Alaska program trains young people to practice mid-level dentistry, something that’s common around the world. This program expands access, improves quality, health, and is less expensive. It’s backed up by rigorous studies, that show mid-level providers offer “safe, competent and affordable care.”

So where is the celebration? Well, that will have to wait until the fight is over.

Washington state is considering legislation that would expand mid-level providers and the Washington State Dental Association is opposed saying that “midlevel providers will not make dental care more affordable, how dental residencies are a superior alternative, and how dentists in private practice are reimbursed 25 cents on the dollar for adult Medicaid patients.” (more…)

Another reason Ryan is wrong

trahant MARK
TRAHANT

 
Austerity

Paul Ryan is wrong. Way wrong.

On Monday the former Republican candidate for Vice President released a review of programs that attack the “war on poverty.” The House Budget Chairman said: “This 50th anniversary of the War on Poverty is an opportunity to review the record in full. And we should seize it.”

Ryan said the federal government has “measured compassion by how much we spend instead of how many people get out of poverty. We need to take a hard look at what the federal government is doing and ask, ‘Is this working?’ This report will help start the conversation. It shows that some programs work; others don't. And for many of them, we just don't know.”

The premise that underlies this report is Ryan, and Republicans, firmly held philosophy that government is not capable about solving problems. This is another push to shrink the federal government.

That said: A debate about the role of government is fair. It’s worth Republicans making their case that a smaller, stingy government would be effective. Then those candidates can take that message to the voters for affirmation (or more likely, rejection).

However when it comes to Indian health, Ryan’s War on Poverty review is factually incorrect. The Ryan report lumps the Indian Health Service in with other social programs. The history is described this way: “The IHS was officially established within the Department of Health and Human Services in 1955 (then the Department of Health, Education, and Welfare) as part of the Transfer Act. But the federal initiatives designed to increase access to health services for tribal members existed as far back as 1830.” (more…)

Not honorable, but right in some ways

trahant MARK
TRAHANT

 
Austerity

President Obama’s next budget, due to be released soon, will be good news for Indian Country.

The Washington Post describes the plan this way: “With the 2015 budget request, Obama will call for an end to the era of austerity that has dogged much of his presidency and to his efforts to find common ground with Republicans. Instead, the president will focus on pumping new cash into job training, early-childhood education and other programs aimed at bolstering the middle class, providing Democrats with a policy blueprint heading into the midterm elections.”

So does this mean austerity will end in Indian Country? Unfortunately, no. But this budget is a new approach -- and it will have many implications in Indian Country.
Let me explain. It starts with this whole business of “austerity” or a government that shrinks itself and the economy.

The problem, essentially, in recent years is that Democrats have bought into the premise of austerity. There is this idea that a smaller government will somehow right the economy because the private sector will then create more jobs. Nonsense. There is far more evidence that when government invests in the economy there will be growth ahead.

The president’s budget adds an important twist to this debate by calling for sharp reductions in military spending. This will not be popular with Republicans (even though the U.S. spends $600 billion a year, more than the next ten nations combined on defense.)

There should be little debate among tribal governments about austerity. There is not much of a private sector in tribal nations to pick up the slack. So any significant reduction in government, whether it be welfare payments or support for law enforcement programs, reduces the number of jobs at home.

Spending for programs that directly benefit American Indians and Alaska Natives -- such as the Bureau of Indian Affairs or the Indian Health Service -- are from the portion of the budget that’s considered discretionary spending. Every dollar has to be appropriated by both houses of Congress and signed into law by the president. There has to be a “deal” to spend the money.

And discretionary spending is shrinking. Last year it totaled about $1.2 trillion and is projected to drop by $7 billion, less than 1 percent, in 2014.

The budgets that are growing are “mandatory” spending, money that’s automatic, such as Social Security, Medicare and Medicaid. (more…)

Will you die waiting?

trahant MARK
TRAHANT

 
Austerity

On a tribal bulletin board this week these chilling words were posted: “Due to budget issues, Contract Health Service will be on Priority One until further notice.”

Why are these words frightening? It means the underfunded local unit of the Indian Health Service is out of money on an important line item. It means that unless your illness is serious -- threatening life or limb -- you will have to wait.

Sometimes that wait can be deadly. And it’s wrong. It reflects a system that is out of balance and the consequences are life threatening to American Indians and Alaska Natives.

A couple of years ago, at a Senate hearing, a story was told about a heart attack patient who was left on a gurney with a note taped on her thigh that read: “If you admit this person, understand we're out of contract health care money. Do it at your risk.”

The Affordable Care Act, or Obamacare, is supposed to eliminate this underfunding. The complicated mechanism is designed to increase the number of American Indians and Alaska Natives with basic insurance, Medicaid, tribal insurance, or a policy from a marketplace exchange, money that then goes into the Indian health system directly. The Affordable Care Act is designed to substantially increase third-party billing, a revenue stream that does not require appropriation from Congress. And, I should add, a revenue stream that could add a couple of billion dollars to the Indian health system. Full funding ... in theory.

So what’s the problem? Why is there a bulletin board warning patients that’s there is not enough money?

The main reason is that critics of the Affordable Care Act are determined to make certain that this law is a wreck. Instead of figuring how to make it so, many so-called leaders are working overtime to tank every aspect of the act.

Just a couple of weeks ago, Wisconsin Republican Sen. Ron Johnson said it was time to “recognize reality” and “deal with the people that are currently covered under Obamacare.”

But that was then. Now three Republican senators, Richard Burr (N.C.), Tom Coburn, (Okla.), and Orrin Hatch (Utah), are launching a campaign to start the debate all over, promoting a “replacement” plan for Obamacare. That plan would make it even more difficult to fund the Indian health system. “Under our proposal, restrictions that limit the ability for veterans, service members, and individuals receiving care through the Indian Health Service would be removed in order to ensure that these individuals also have the ability to benefit from health savings accounts in managing their health care needs and expenses,” according to the plan. (more…)

A part of the state of the union

trahant MARK
TRAHANT

 
Austerity

The thing I like about state of unions -- the national kind, the NCAI kind, and the tribal kind -- is that it’s a to do list. Leaders see this is a list of “action items” while I see this as a list of fascinating issues that are worth exploring in future columns.

I want to start with an idea raised by President Barack Obama in his State of the Union message: “Let’s make this a year of action. That’s what most Americans want – for all of us in this chamber to focus on their lives, their hopes, their aspirations.”

What would a “year of action” look like in Indian Country? And, more important, how do we get there?

National Congress of American Indians President Brian Cladoosby began this year’s State of Indian Nations by talking about so many of the success stories from Indian Country. “Tribal leaders and advocates have never been more optimistic about the future of native people,” he said. But that sense of possibility is “threatened by the federal government’s ability to deliver its promises.”

President Cladoosby released NCAI’s budget request for the coming fiscal year. That document calls for funding treaty obligations with the “fundamental goal” of parity for Indian Country with “similarly situated governments.” As a moral case, and cause, this is exactly right. This is an aspirational document, as it should be.

But in a year of action there needs to be another route forward. This Congress is incapable of honoring treaties. Even in a more friendly era, members of Congress proudly called Indian health a “treaty right” only to appropriate less than what was required. This year’s federal budget essentially is flat (which means less program dollars because Indian Country’s population is growing). NCAI puts it this way: “However, the trend in funding for Indian Affairs in the Department of the Interior does not reflect Indian self-determination as a priority in the federal budget.”

But it’s not the Interior Department. It’s all of government and especially the Congress. (more…)

Year of the native voter?

trahant MARK
TRAHANT

 
Austerity

Could this be the year of the Native voter?

That’s a tall order for a population that’s less than one percent of the country. But American Indians were key contributors to winning coalitions in Wisconsin, North Dakota and Montana two years ago and there is the potential to do even better this time around.

Three things have to happen first, though. There must be candidates who are inspirational. Next, there must be organization and money. And, third, American Indians and Alaska Natives have to actually vote.

Step one is on target. There are already more high profile candidates for office in 2014 than in any election I can recall. For example, former Colville tribal chairman Joe Pakootas is running against Rep. Cathy McMorris-Rodgers in Washington state. This is a tough race, but Pakootas has a great election narrative: How he turned around a money-losing tribal enterprise and made it profitable, creating jobs along the way.

The candidacy of Byron Mallott for governor of Alaska has to be at the top of any list. Mallott has the ideal resume. He’s a member of the Yakutat Tlingit Tribe, and a clan leader of the Kwaashk'i Kwáan of the Raven people. He has worked in state government and as the chief executive of Sealaska corporation. Mallott was mayor of two towns including Juneau, the state capital.

Mallott’s path to the Democratic Party nomination is clear so he will face incumbent, Republican Gov. Sean Parnell.

Parnell, it seems, has gone out of his way to be on the other side of Alaska Native issues. The governor rejected Medicaid expansion, saying the federal Indian Health Service is good enough health care access for Alaska Natives. This is absurd. There is not enough money in the Indian health system. But at the same time he tells the federal government to cover health care for Alaska Natives, the governor demands sovereignty over subsistence hunting and fishing asking for a Supreme Court review of the Katie John case. (more…)