The promise from President Donald J. Trump and Congress to quickly repeal and replace the Affordable Care Act has failed. What does this mean for the Indian health system?
This is Trahant Reports.
It’s easy to see the defeat of Trump and Ryan’s healthcare plan as a huge win. But it is also a warning sign. Make that a flashing red light with sirens. The problem is that Congress is deeply divided and cannot govern.
But Indian Country can still move forward.
There is a legal understanding that Indian health system is federal obligation that stems from treaty promises to provide doctors and nurses to tribal communities. Yet no Democrat nor Republican government has ever (as in ever) proposed fully-funding that Indian health system.
Most of the Indian Health Service budget, about 80 percent, is money appropriated by Congress. But 20 percent of that money comes from a variety of insurance programs. That’s money that can grow and improve medical care.
The idea was that one way to get more money into Indian health was to get a higher percentage of Native Americans insured. The federal government — remember there is a treaty obligation here — picks up the cost of that insurance. This makes full-funding of Indian health a possibility.
So here are three ways to add funding to Indian health.
First: Sign up more American Indians and Alaska Natives for Medicaid. The fact is there are many more people eligible than enrolled. Already Medicaid covers more than half of all Native American children but at least 11 percent remain uninsured.
Second: More American Indians and Alaska Natives should join exchange plans under the Affordable Care Act. This is huge. According to healthcare.gov “If you get services from an Indian Health Care Provider, you won’t have any out-of-pocket costs like copayments, coinsurance, or deductibles, regardless of your income.
Signing up for insurance (including plans from an employer) makes the Indian health system stronger for everyone.
Third: It’s time to make the case for Medicaid expansion in state governments that have said no. Now that the Affordable Care Act remains the law of the land there is unequal funding. States can remedy that by expanding Medicaid eligibility rules. If that happens it’s a win for Indian Country because it increases the number of people eligible for insurance. Nineteen states have yet to expand Medicaid, including Oklahoma and South Dakota.
The failure of Congress to repeal the Affordable Care Act is a green light to add more American Indians and Alaska Natives to the ranks of the insured. And that’s money that goes directly to the Indian health system without Congress ever having to appropriate a single dime.
I am Mark Trahant.
