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Blackfeet Chairman Harry Barnes and Interior Secretary Ryan Zinke sign a modern treaty, the Blackfeet Water Compact. (Trahant photo)

What does a treaty look like these days?

This is Trahant Reports.

Historians will often say the formal treaty era between tribes and the United States ended in 1871. The evidence is language inserted into an appropriations bill that clearly stated “henceforth, no Indian nation or tribe . . . shall be acknowledged or recognized as an independent nation, tribe or power with whom the United States may contract by treaty.”

But watch what Congress does, not what it says. The treaty era, no matter what it is called, continues to this day. And it’s still quite formal.

Last week three governments came together in a formal ceremony at the Department of Interior to sign and celebrate the Blackfeet Water Compact.

This begins the implementation phase of a modern treaty that has been in negotiation for three decades.

The compact required approval of the tribe, Montana, and the United States. The Montana Legislature approved the compact in 2009. Congress passed a bill that was then signed into law by President Obama on December 16, 2016, which provided federal approval of the compact as well as $422 million (in addition to the state contribution of $49 million) in funding for water-related projects on the Reservation. Then on April 20, 2017, Blackfeet citizens voted to approve the Blackfeet Water Compact and Settlement Act. The idea of water settlements is that they are a more effective path than litigation, which can take even longer, and end up being less satisfactory to all of the parties involved. Settlements, on the other hand, quantify the water rights and provide certainty to water users.

“It has been a long arduous journey, a tough journey,” said Blackfeet Chairman Harry Barnes in Washington last week.

“This is historic,” said Interior Secretary Ryan Zinke Tuesday. “One of the challenges is over, a compact between nations.”

Montana Sen. Jon Tester, a Democrat, echoed the historic nature of the settlement and said he would continue to press in the Congress for funding of all the promises.

Paying the full cost of the compact’s implementation remains a challenge. In

The total cost of the compact will be $422 million, plus the state’s contribution of $49 million. So far Tester has been able to secure $10 million in federal funds.

This might be a era for a treaty-like promise. The Supreme Court Monday effectively held the state of Washington and the United States to live up to a treaty right (no matter the cost). So this treaty, formal or not, now puts the United States on record with a new promise to fund water projects.

I am Mark Trahant.

New Medicaid rules by the Trump administration undermine the treaty right to health care.

The Trump administration is supporting a major policy shift on Indian health programs which could result in a loss of millions of dollars and sabotage treaty rights.

This is Trahant Reports.

A story in Politico Sunday raised the issue, saying the Trump administration contends the tribes are a race rather than separate governments, and exempting them from Medicaid work rules would be illegal preferential treatment.

The new policy on Medicaid work requirements “does not honor the duty of the federal government to uphold the government-to-government relationship and recognize the political status enshrined in the Constitution, treaties, federal statutes, and other federal laws, said Jacqueline Pata, executive director of the National Congress of American Indians.

Medicaid has become a key funding stream for the Indian health system — especially in programs managed by tribes and non-profits. Medicaid is a state-federal partnership and public insurance. The Affordable Care Act expanded Medicaid eligibility, but the Supreme Court ruled that each state could decide whether or not to expand. Since the expansion of Medicaid some 237,000 American Indians and Alaska Natives in 19 states have become insured.

Officially Medicaid represents 13 percent of the Indian Health Service’s $6.1 billion budget (just under $800 million).

But even that number is misleading because it does not include money collected from third-party billing from tribal and non-profit organizations. In Alaska, for example, the entire Alaska Native health system is operated by tribes or tribal organizations and the state says 40 percent of its $1.8 billion Medicaid budget is spent on Alaska Native patients. That one state approaches the entire “budgeted” amount for Medicaid.

Those Medicaid (and all insurance) dollars are even more significant because by law they remain with local service units where the patient is treated (and the insurance is billed). And, unlike IHS funds, Medicaid is an entitlement. So if a person is eligible, the money follows.

Medicaid is the largest health insurance program in America, insuring one in five adults, and many with complex and long-term chronic care needs. The Trump administration and many state legislatures controlled by Republicans see Medicaid as a welfare program. While most Democrats view it simply as a public health insurance program.

Work rules are particularly challenging for Indian Country. Unlike other Medicaid programs, patients in the Indian health system will still be eligible to receive basic care. So stricter rules will mean fewer people will sign up for Medicaid and the Indian Health Service — already significantly underfunded — will have to pick up the extra costs from existing appropriations. That will result in less money, and fewer healthcare services, across the board.

I am Mark Trahant.