We live in odd times. Congress is moving forward with promised legislation that would roll back much of the health care reform enacted during the past eight years. The Trump administration is issuing regulations to do the same. But in state capitals there are real debates about public policy.
This is Trahant Reports.
The future of the Affordable Care Act is a case in point. Republicans in Congress are eager to ditch the law, but coming up with a replacement or even a fix is a much more difficult task.
Yet in state capitals there is an understanding that a wholesale repeal of the law could be a disaster. So many Republicans at the state level, such as Ohio Gov. John Kaisch, are pushing back. He recently told CNN that that any repeal without addressing Medicaid expansion is a “very, very bad idea.”
Several states prefer a real solution, one that doesn’t grab as many headlines. And that is to continue with current law and then Secretary of Health and Human Services Tom Price would grant states many more waivers to design the programs the way they want.
Medicaid is a huge issue for Indian Country because it could fund more patients who currently use the Indian health system. States also come out ahead with American Indian and Alaska Native clients because the federal government is obligated to pick up the tab.
Last week in Washington state there was a victory for health care reform in Indian Country. The Legislature passed, and Gov. Jay Inslee, signed into law, a measure that opens up the practice of dental health therapy.
Dental health therapists are mid-level providers. They work under the supervision of a dentist and offer routine and preventive services.
Most experts in health care reform argue for increasing value in health care by lowering costs and at the same time improving quality. This is that.
This oral health reform was started a decade ago by Alaska Native Tribal Health Consortium. It’s an idea that works. Since the creation of this midlevel dental practice some 45,000 Alaska Natives have gained access to care and it’s vastly improved oral health.
This story is a great example of the principle of lead, follow, or get the hell out of the way.
A year ago Swinomish President Brian Cladoosby announced that the tribe was using its sovereign powers to hire a dental health therapist in contradiction to federal and state law. The case was clear that the tribe had the authority even while raising questions about Medicaid funding or licensing. (The American Dental Association had been successful getting language into the Affordable Care Act that required state action.) But the state of Washington was reasonable and the result is the new law and better oral health for Native Americans.
In the years ahead look for more action and success stories coming from state capitals. I am Mark Trahant.
