Writings and observations

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.”

What the Ryan report calls a “federal initiative,” I would call a treaty obligation. No where in this report is there a mention of why the federal government funds and operates Indian health programs. Nearly every treaty in the United States, the supreme law of the land, has a health care provision. A provision that has never been fully funded.

Of course the Ryan report looks at this differently, too. It said that the Office of Management and Budget “found IHS to be an effective program” and since its transfer until 1995, “the Indian Health Service reduced the years of potential life lost—a measure used to gauge overall health—among American Indians and Alaska Natives by 50 percent.”

The Ryan report’s conclusion: “However, the program could not show the relationship between specific health outcomes and funding.” But it lists the $4.3 billion was appropriated for Indian health.

Oh yeah. The report never mentions the funding shortfall for Indian health, a fact that’s clearly in the public record. The Ryan report doesn’t bother to show that per person spending for Indian health is far below the average cost of care for other citizens. By framing Indian health as a “war on poverty program” it’s easy to dismiss a constitutional promise as just another government program.

The context for this new Ryan approach is the recent budget proposals from his committee. Ryan’s budgets would slash $637 million from the Indian Health Service budget. (The good news is that Ryan most likely will not propose a budget this year; there are not 215 votes to be found in the House for any single Republican spending plan.) And the Ryan-Murray deal was a two-year bridge. The idea, from both Republicans and Democrats, is to move the debate past the election because both sides hope for more votes.

The Ryan approach to Indian Country is quite clear. End Medicaid and give the money to states (that’s worth a column by itself). Then drastically curtail funding for the Indian Health system. And, finally, pretend treaty promises never existed.

Paul Ryan is just wrong.

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

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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.

The difference between the growing mandatory spending and the shrinking discretionary accounts are why it is so essential for American Indians and Alaska Natives to sign up under the Affordable Care Act. It moves funding for Indian health into the automatic spending category.
The president’s new budget does not change that landscape. There are still huge fights ahead over discretionary spending and mandatory spending will continue to grow.

But now, at least, the budget negotiations will not start off with concessions to Republicans. Every part of the budget will be negotiated with the president’s party calling for investment and Republicans countering with more austerity.

The bad news for tribal communities is that any budget that this Congress enacts will be less, far less, that what the president proposes. There are not enough votes in either House to end austerity.

This, of course, is why elections matter. The philosophical debate between austerity versus investment ought to be front in center in November 2014.

It’s not enough, it seems to me, for a candidate to “support” Indian programs all the while advocating for budgets that shrink government because Indian Country cannot escape that larger ideology. On the other hand, should the investment argument win, Indian Country will benefit.

In its budget outlook, the National Congress of American Indians said that “shrinking resources due to sequestration and the Budget Control Act have adversely affected tribes’ ability to meet the needs of their communities.” NCAI called for “an honorable budget for Indian Country will empower tribes so they can provide their people with good health care, quality education, decent and adequate housing, and a level of public safety that any American citizen has the right to demand.”

We won’t know for a couple of weeks if the president’s budget meets the test of “an honorable budget.” But at least we know it’s headed in the right direction. It’s time for austerity to go away.

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

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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.

This bill would also repeal the Indian Health Care Improvement Act. And treaty rights? Gone. Unfunded.

That Republican bill will go no where as long as President Obama (or another Democrat) is in office. But a second, more serious, threat to the law is occurring in state capitals across the country. The way the law was drafted, the primary funding vehicle was to expand Medicaid to buy insurance for people who are currently uninsured. (According to the Kaiser Family Foundation, that’s one-in-three American Indians and Alaska Natives.)

The federal government made this a good deal for the states: Paying all of the cost for the first three years and nearly all of the cost after that. Half the states have said “no.” Republicans are using this as their line in the sand again Obamacare.

A study published last week in Health Affairs said that this approach has serious consequences, the failure of Medicaid expansion will result in premature deaths. “We predict that many low-income women will forego recommended breast and cervical cancer screening; diabetics will forego medications, and all low-income adults will face a greater likelihood of depression, catastrophic medical expenses, and death,” the study reported. “Disparities in access to care based on state of residence will increase. Because the federal government will pay 100 percent of increased costs associated with Medicaid expansion for the first three years (and 90 percent thereafter), opt-out states are also turning down billions of dollars of potential revenue, which might strengthen their local economy.”

The study’s authors, Sam Dickman, David Himmelstein, Danny McCormick, and Steffie Woolhandler, charted the number of uninsured who would miss out on treatment and estimated a range of potential early deaths, some 7,000 to 17,000 across the country. Many of the “no” states have large American Indian and Alaska Native populations. Roughly half the Indian health system is in states without Medicaid expansion.

Conservatives are already discounting the Health Affairs report. Chris Conover counters: “I can state with great confidence that the authors have grossly overestimated any mortality gains to be had from Medicaid expansion.”

But in neither study was there data or anecdotes about tribal communities with a bulletin board post warning patients that the clinic is out of money.

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

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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.

To my way of thinking, this particular moment in history is especially important. The demographics of Indian Country — a young, growing population — exactly matches the greater need of the nation as a whole (a nation that is rapidly aging). Cladoosby said in the past thirty years the number of American Indian and Alaska Natives in college has more than double.

Cladoosby, who is chairman of the Swinomish Indian Community, said that his tribe is providing scholarships for their young people to the colleges of their choice. That’s smart. I wish more tribes could afford that approach. But there are other ways that this can happen, too.

So here is one idea: What if President Obama, when he visits Indian Country this year, partners with tribal leaders to raise private money for tribal colleges? How much is possible, a billion endowment? Why not?

Or what about expanding efforts to forgive student debt? Too many young Native Americans are burdened by loans. If tribal members choose to be teachers or serve tribal governments, erase what they owe. (And expand similar programs for young people who choose health care careers.)

Two other items in the State of Indian Nations that are important and exciting are tribes building international partnerships, President Cladoosby mentioned Turkey, as well as tax reform so that tribes can raise their own funds. He said tribes should get at least the same tax treatment as states. This could be new money. Action dollars.

In a year of action, it seems to me, the most lucrative routes do not involve Congress or appropriations.

In his congressional response, Montana Sen. Jon Tester hit on a couple of billion dollars just waiting to be picked up, and that’s the Affordable Care Act. Congress is not going to fully fund IHS. But that full-funding could happen if every eligible American Indian and Alaska Native signed up for tribal insurance, Medicaid, or purchased a free or subsidized policy through an exchange. This is money that Congress does not have to appropriate.

A couple billion dollars? Just waiting for a year of action.

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

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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.

This set of facts ought to be enough to motivate Alaska Native voters.

But that requires follow through on the next two steps, organization (including money) and then actual voting. I looked at the last election, precinct by precinct, and turnout by Alaska Natives in villages ranged from a low of 25 percent to 71 percent. It was mostly lower (with a couple of exceptions) than the statewide turnout and by a wide margin, ten, twenty and even thirty points.

It’s these kind of numbers that led the National Congress of American Indians in 2012 to declare a “civic emergency” regarding voter registration.

The NCAI report calls for voter registration at Indian health facilities. This is the perfect solution for the 2014 election: Encourage people to sign up for health insurance and register to vote at the same time. Imagine how the Alaska’s politics would be if the Alaska Native voter registration was higher. (New Mexico has the highest percentage of Native American voters at 77 percent.) Alaska Natives could have a bigger share of the electorate than in any other state. Alaska has extraordinary challenges that limit Native voting. The logistics of a high turnout election are daunting, much more complex than in any other part of the country, and state institutions continues to depress turnout and throw up barriers to limit Alaska Native voters. That’s why the payoff could be that much sweeter. Alaska Natives could the key bloc that elects governors, senators, and, federal representatives, pretty much determining the state’s future.

So here’s the thing: This will be a be low turnout election anyway. Americans get excited over presidential elections and then fade into the background two years later. Indian Country is the same. We vote in presidential years, but there is even much more potential to swing elections two years later. That time is now.

So that means if Indian Country does get organized, and folks actually vote, then the power of that Native vote is amplified. There is time to make 2014 the year of the Native voter.

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

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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

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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

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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:
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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:
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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

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