Brandon Ecoffey: Treaties guaranteed health care for our people

Brandon Ecoffey

A note from the editor’s desk
By Brandon Ecoffey
Lakota Country Times Editor

The Medicaid expansion debate in South Dakota is incredibly intriguing when looked at from the perspective of tribal nations.

South Dakota is one of the last remaining states who have resisted opting in to a portion of the Affordable Care Act that would expand Medicaid coverage to include about 48,000 South Dakotans who live just above the poverty line.

On January 12, South Dakota Gov. Dennis Daugaard, outlined a plan for expansion in South Dakota that would force the federal government to pay for a percentage of Medicaid costs incurred by individual Native Americans across the state. When an individual covered under Medicaid visits a provider, only a portion of the bill is covered by Medicaid, for Native Americans using a non-IHS facility, the remaining balance on the bill is currently picked up by the state. To pay for the state’s required portion of the expansion, Gov. Daugaard wants the federal government to fulfill its “treaty obligations” by picking up the leftover fees of individual Native Americans. The money saved by the state would then be used to pay for Medicaid expansion across the state. The federal government has not yet indicated if it will take the deal and cover the costs.

The interplay between the competing interests within this issue is complex and shines a light on the perspective from which both federal and state Indian policies are originated.

The position taken by Gov. Daugaard is a bit ironic. When was the last time a Republican from South Dakota attempted to hold the federal government accountable for its treaty obligations to tribal-nations? The position taken by the governor would seem to imply that he acknowledges the legal validity of the treaties. If this is the case, then other portions of the treaties must also be acknowledged as legitimate. If this is the case then state policies towards tribal-nations must be amended to reflect this acknowledgement.

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Now, for the feds, it is really quite simple. They get another holdout republican state to expand Medicaid in exchange they must fulfill their trust and treaty obligations and pay for the healthcare of Native people. How will federal officials respond to a state governor’s demands that they fulfill their longstanding promises to tribal-nations?

For Native people the push and pull between South Dakota and the Federal government is perplexing. As tax paying citizens of South Dakota it is just as much the responsibility of the state to step up and pay for our citizens who are living off the reservation. Our people living off the reservation pay the same tax rates as every other resident of South Dakota and are entitled to the same benefits that everyone else receive. Those state services cannot be divided up based on race.

Ultimately it is the role of the federal government to work with tribes. Our longstanding treaty relationship with the federal government is must should guide all federal Indian policy. These treaties guaranteed healthcare for our people.

(Brandon Ecoffey is the editor of Lakota Country Times and and award winning journalist who was born and raised on the Pine Ridge Indian Reservation. He can be reached at

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