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What can American Indians and Alaska Natives expect from a Donald Trump administration? Let’s start with a billion dollar dilemma.

This is Trahant Reports.

When it comes to the federal relationship with American Indian and Alaska Native governments as sovereigns we will likely see ideas pop up that were long ago discarded as impractical, expensive, or out and out wrong.

At the top of that list: Shifting power from the federal government to state capitals. That was Ronald Reagan’s plan when he came to Washington. In 1981 he proposed rolling dozens of federal programs into block grants for states. Then the budget was cut by 25 percent, the argument being states could deliver the services more efficiently. But even a Republican Senate did not buy the whole plan.

So now Republicans, led by House Speaker Paul Ryan, will take another shot at creating state block grants.

Ryan’s agenda, “A Better Way,” proposes to do this with Medicaid. “Instead of shackling states with more mandates, our plan empowers states to design Medicaid programs that best meet their needs, which will help reduce costs and improve care for our most vulnerable citizens,” the speaker’s plan says.

This is a significant issue for the Indian health system. Under current law, Medicaid is a partnership between the federal and state governments. And states get a 100 percent federal match for patients within the Indian health system.

Four-in-ten Native Americans are eligible for Medicaid funding, and, according to Kaiser Family Foundation, at least 65,000 Native Americans don’t get coverage because they live in states that did not expand Medicaid.

The Affordable Care Act, which is priority one for repeal and replacement, uses third-party billing as a funding source for Indian health programs because it can grow without congressional appropriations. The idea is that when a person is eligible, the money is there. The Indian Health Service budget in fy 2017 includes $1.19 billion in third-party billing, $807 million from Medicaid programs. This funding source is especially important because by law third-party billing remains at the local clinic or other unit. And, most important, when the Indian Health Service runs short of appropriated dollars, it rations health care. That’s not the case with Medicaid funding.

Ryan’s House plan would convert Medicaid spending to a per capita entitlement or a block grant depending on the state’s choice. And there is no indication yet how the Indian health system would get any money through such a mechanism.

During the campaign Trump promised to repeal the Affordable Care Act, including Medicaid expansion, but said there would be a replacement insurance program of some kind.

Last week Rep. Tom Cole, R-Oklahoma, said on CSPAN that the Indian Health Care Improvement Act was one of the good features of the Affordable Care Act and ought to be kept. But nothing has been said by Republican leaders about how to replace a funding stream from Medicaid, potentially stripping money from an Indian health system that is by all measures underfunded.

I am Mark Trahant.

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This election Indian Country was like America. Perhaps only more so.

This is Trahant Reports.

Most American Indian and Alaska Natives voted for Hillary Clinton. There were not enough votes to make a difference in red states like Montana, South Dakota and North Dakota. Just enough votes to stay the course in blue states like New Mexico, Washington or Oregon. And, most important, not nearly enough votes in the swing states.

Hillary Clinton earned 60, 839,922 votes to Donald J. Trump’s 60,265,858. But that, of course, is not the way we elect the national leader and Trump’s 290 electoral votes were more than enough to win.

If you look at a color coded 2012 election map Indian Country pops out. There are bright blue pools of voters in deeply red states. Shannon County (now Oglala Lakota County) voted 93.4 percent for Obama. That’s Pine Ridge. Obama won 3/4s of the vote in Rolette County, North Dakota, which includes the Turtle Mountain Band of Chippewas.

Or next door in Montana, voters from the Fort Peck Reservation came out and led the county with 56.5 percent voting for Obama. But blue faded in the red states this election. Trump picked up 200 more votes than Mitt Romney in 2012, but the real number is that nearly 600 fewer voters went for Hillary Clinton compared to Barack Obama.
Same story in Oglala Lakota Country. Clinton won, and by a large margin, but with 500 fewer votes than Obama.

In Rolette County nearly 1,300 fewer votes for Clinton.

The red states did not change because of that but it’s a good indication about how tepid the support for Clinton was, even in Indian Country.

This story played out in blue states, too. More than 2,000 voters disappeared in McKinley County on the Navajo Nation in New Mexico.

And, in swing states, such as Arizona, that slight difference, a few hundred people who did not vote here and there, added up to real numbers. In Apache County, where the majority of the voters are Navajo, 17,147 picked Obama four years ago. This election only 12,196 voted for Clinton.

Indian Country will make a difference in future elections. The demographic makeup of the country is changing fast and we are a part of that.

I also think it’s clear that Clinton took Indian Country for granted. There was no attempt to learn

and execute what worked from the Bernie Sanders campaign.

And ignoring Standing Rock was a sure way to turn off Native voters. There was probably a “let’s get past the election” conversation, although eventually Tim Kane did weigh in, but nothing changed the narrative that Clinton represented more corporate power, not less. Supporting Standing Rock would have been the right call.

Yet that might be the essence of Hillary Clinton and why she lost. Her campaign was a package of powerful interests trying to market itself as the voice of ordinary people. Indian Country’s answer was, yeah, whatever. Meh.

I am Mark Trahant.