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Tribes working to protect Indian health with Donald Trump in office

Friday, November 11, 2016

The Alaska Native Medical Center in Anchorage, Alaska. Photo from Facebook

With Republican Donald Trump headed to the White House and Republicans in control of the U.S. Congress, a major threat looms over the Indian health care system.

During his campaign, the president-elect repeatedly called the Affordable Care Act a "disaster." Come January 2017, he plans to join Republicans in the House and in the Senate in repealing the historic 2010 law that allowed millions of American citizens to obtain health insurance for the first time.

"Let us be clear: President-Elect Trump has put forth a plan to revoke the Affordable Care Act on his first day in office," Lester Secatero, the chairman of the National Indian Health Board, said in a statement on Thursday.

A devastating side effect of that effort would be the loss of the Indian Health Care Improvement Act. The law, which updates crucial programs to address the unique and pressing health needs of the first Americans, was included in the ACA.

The IHCIA also was made permanent, a significant achievement, considering that tribes spent more than a decade trying to get it passed during the Bush era.

But Republican lawmakers have voted to repeal the ACA, defund it, or delay it more than 50 times since 2010, according to Democrats. Even the only two tribal citizens in Congress -- Rep. Tom Cole (R-Oklahoma), who is from the Chickasaw Nation, and Rep. Markwayne Mullin (R-Oklahoma), who is from the Cherokee Nation -- have joined those efforts on different occasions.

At the same time, Republicans have never acknowledged or explained how their actions will impact the Indian Health Service So Secatero, who is a citizen of the Navajo Nation from To'hajiilee, said his organization will be working with lawmakers to "ensure the Indian Health Care Improvement Act remains intact."

"In addition, NIHB is analyzing the potential impact on Native health and access to care that will happen as a result of ACA repeal," Secatero said. "We will provide that analysis on an ongoing basis and it will serve as the foundation for future action."

Secatero also said the organization will be reaching out to the Trump transition team -- dubbed greatagain.gov, a reflection of the candidate's campaign slogan -- to recommend tribal citizens to serve at the IHS and the Department of Health and Human Services, its parent agency. A meeting will take place in Washington, D.C., on December 8 to prepare for the new administration.

"NIHB will convene tribes across the nation and lead a national, tribal discussion to create a strategic path forward that stands on sovereignty, self-governance, treaties, the Constitution and policy," Secatero said.

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When the 115th Congress convenes in January, the bill to repeal the ACA and the IHCIA is expected to be among the first in line. The effort is part of A Better Way, the conservative agenda being advanced by Rep. Paul Ryan (R-Wisconsin), the Speaker of the House, who incidentally had abandoned Trump in the weeks before Tuesday's election.

"No one can really speak to what's in it or not in it at this time," Jacqueline Pata, the executive director of the National Congress of American Indians, said during a post-election webinar on Thursday, adding that her organization also will work with Congress to protect Indian health care.

The Affordable Care Act requires all Americans to carry health insurance. In most situations, coverage is provided by employers but others are required to purchase it.

Tribal citizens who receive their care through the Indian Health Service, however, are exempt from the mandate so repealing the law would not have an effect on that front.

But in addition to a permanent reauthorization of the Indian Health Care Improvement Act, the law helps Indian Country in other ways. One provision, for example, prevents tribal benefits from being taxed by the Internal Revenue Service, an issue that was affecting tribes nationwide.

Another provision, however, penalized tribes with million of dollars in fines for failing to provide health coverage to their employees. Republicans are supporting a bill to address the issue, to the opposition of Democrats.

Trump has tapped Andrew Bremberg, a former HHS staffer and former Republican Congressional staffer, as his lead for the department. He also served on the Republican Party's platform committee staff.

"Republicans reject a one-size-fits-all approach to federal-tribal-state partnerships and will work to expand local autonomy where tribal governments seek it," the 2016 platform reads. "Better partnerships will help us to expand Republicans reject a one-size-fits-all approach to federal-tribal-state partnerships and will work to expand local autonomy where tribal governments seek it. Better partnerships will help us to expand."