The Keams Canyon Hospital in Arizona. Photo from Indian Health Service

Congress would strip millions of dollars from the Indian health system
By Mark Trahant
Trahant Reports

The U.S. Senate is debating a measure this week that would repeal much of the Affordable Care Act (also known as Obamacare). Senate leaders are using a budget process called reconciliation which is important because only 51 “yeas” are required for the bill to pass.

On October 23 the House passed H.R.3762, Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015 that would end the Affordable Care Act budget provisions and “terminate the Prevention and Public Health Fund, which provides for investment in prevention and public health programs to improve health and help restrain the rate of growth in health care costs. Unobligated funds are rescinded.” The bill also says no federal funds can be used for Planned Parenthood.

It’s really not news when the House repeals the Affordable Care Act. That body has voted for at least fifty repeals. The Senate has been a different story. A full repeal of the bill would need a supermajority of 60 votes. That’s why Republican leaders are using the reconciliation process (the same process that was used to originally pass the Affordable Care Act in 2010.

Senate Majority Leader Mitch McConnell said: “Obamacare’s structural failures are … baked into the law, and they only seem to get worse as time moves on. Just as we’ve seen costs rise, choices narrow, and failures mount, we’ve seen congressional Democrats block attempts to start over with real health reform. This week, we finally have a chance to vote to end Obamacare’s cycle of broken promises and failures with just 51 votes.”

Sen. Mitch McConnell (R-Kentucky) speaks to the media at the U.S. Capitol on December 1, 2015. Photo from Twitter

The Senate repeal bill will make health care an election issue. Again. The president is certain to veto any bill and then Republicans can say they delivered on their promise to repeal Obamacare.

The final language of the Senate bill has not been released yet. And once debate begins, the language may change again, as senators will vote on additional amendments. But one provision that will be considered has a direct impact on the Indian health system, the expansion of Medicaid. According to Politico, McConnell’s plan would phase out the expansion of Medicaid over the next two years.

To my way of thinking: Medicaid expansion has been the most successful provision of the Affordable Care Act. A recent study by the Centers for Disease Control found that “the number of uninsured persons continued to decline from 2013. In the first 6 months of 2015, 28.5 million persons of all ages (9.0%) were uninsured at the time of interview—7.5 million fewer persons than in 2014 and 16.3 million fewer than in 2013.” The law is working.

The Indian health system has a lot of money at stake in this debate.

The Alaska Native Medical Center in Anchorage. Photo from Alaska Native Tribal Health Consortium

First, the Indian Health Care Improvement Act is a chapter in the Affordable Care Act. So a repeal, depending on the language, could end many initiatives funded through that law. Second, the House language (and therefore likely the Senate language) is broad in its scope. It says it would “terminate the Prevention and Public Health Fund, which provides for investment in prevention and public health programs to improve health and help restrain the rate of growth in health care costs. Unobligated funds are rescinded.” That would include insurance subsidies that make some insurance plans available to Native Americans at no cost. And, third, a rollback of Medicaid expansion would be a huge hit to Indian health funding. More than a million American Indians and Alaska Natives currently receive Medicaid funding.

The Senate bill, like the many House repeal efforts, has no chance of becoming law while President Obama is in the White House. The bill will likely be vetoed minutes after it reaches the president’s desk.

But this repeal effort will be an issue for voters in 2016.

In Alaska, for example, Gov. Bill Walker agreed to agreed to the Medicaid expansion in July. Its early in the program, but some 20,000 Alaskans are in the process of signing up for the insurance plan and 42,000 are eligible. Those are potential voters who would lose their health insurance plan should the Republicans repeal the Affordable Care Act. Not to mention the money: The state of Alaska is expected to receive more than a billion dollars (creating some 4,000 jobs) from the program.

The state’s senior senator, Lisa Murkowski, a Republican, would be on the ballot defending her vote for a repeal.

It’s a similar story in Montana. The state Legislature recently agreed to expand Medicaid and 10,000 people have signed up before the program begins next month. Medicaid expansion will be an issue in the House race between Republican Rep. Ryan Zinke and the Democratic challenger Denise Juneau.

Ten Republicans are up for re-election in the Senate, representing states where tens of thousands of people have insurance through the Medicaid program.

The extraordinary thing about this new chapter in the debate over health care reform is that opponents of the law are sticking with themes that do not stand up against the data. It’s a fact that fewer Americans are uninsured. It’s a fact that the cost of Medicaid has slowed and that states are spending less under the law. And it’s a fact that the Affordable Care Act has opened new revenue streams to fund the Indian health system.

And the alternative? Republicans say they’ll come up with a new plan in a couple of years. That’s a notion that really ought to be on the ballot.

Mark Trahant is the Charles R. Johnson Endowed Professor of Journalism at the University of North Dakota. He is an independent journalist and a member of The Shoshone-Bannock Tribes. On Twitter @TrahantReports