Mark Trahant: Donald Trump's attack puts the Indian health care system at risk

Wednesday, March 27, 2019  

President Donald J. Trump tells the world he has been exonerated by Special Counsel Robert Mueller, and the whole probe was a waste of time. (And, of course, the news media is to blame as the official enemy of the people.)

Since that story is old, “no collusion,” the White House has started a new one, an all out attack on the Affordable Care Act, including the Indian Health Care Improvement Act. And the chaos is back.

Let’s start at the beginning.

No Collusion, No Obstruction, Complete and Total EXONERATION. KEEP AMERICA GREAT!

— Donald J. Trump (@realDonaldTrump) March 24, 2019

The Mueller Report was delivered to the Department of Justice under an official protocol. The president after reading a summary tweeted: “Total EXONERATION.” The issue is now defined so when parts, or even all, of the Mueller report surface, it will be the attorney general’s interpretation, not the actual report itself, that tells the story.

Yet even that letter goes beyond the presidential tweet. Attorney General William Barr wrote … “while this report does not conclude that the president committed a crime, it also does not exonerate him.” Mueller did not draw a conclusion on that point. The summary goes on to say that Mueller did not write a traditional prosecution document and leaves unresolved the difficult issues of law involving obstruction of justice.

Thus it’s Barr, not Mueller, who concludes there was no crime either on the allegations of obstruction of justice or matters related to Russia’s interference with the election.

The president moved on in a big way. The Justice Department wrote a letter to the 5th U.S. Circuit Court of Appeals that said it would file a brief supporting a district court decision to strike down the entire Affordable Care Act. U.S. District Court Judge Reed O’Connor, a George W. Bush appointee, ruled that since Congress eliminated the individual insurance mandate penalty, the entire law is invalid.

In a legal development that puts the Indian Health Care Improvement Act at risk of being eliminated, the Trump administration is refusing to defend the Affordable Care Act. The case comes from the same judge who struck down the Indian Child Welfare Act. https://t.co/0sxLn8khhM

— indianz.com (@indianz) March 26, 2019

“The United States healthcare system touches millions of lives in a daily and deeply personal way. Health-insurance policy is therefore a politically charged affair—inflaming emotions and testing civility. But Article III courts, the Supreme Court has confirmed, are not tasked with, nor are they suited to, policymaking,” Judge O’Connor wrote. “And sometimes, a court must determine whether the Constitution grants Congress the power it asserts and what results if it does not. If a party shows that a policymaker exceeded the authority granted it by the Constitution, the fruit of that unauthorized action cannot stand.”

No matter how the appeals court rules, this matter is likely to be before the U.S. Supreme Court.

Striking down the Affordable Care Act would have immediate impact for more than 20 million Americans who are covered by insurance through Medicaid Expansion or insurance exchanges. The law includes the Indian Health Care Improvement Act -- and that would be included in a rollback of the legislation.

It’s hard to understate the significance of a judicial repeal of the Affordable Care Act. Medicaid, for example, is now a significant source of funding for the Indian Health system especially for facilities managed by tribes and non-profit organizations. More than one out of every four Native patients in the Indian health system are covered by Medicaid.

A study in 2017 by the Kaiser Family Foundation said Medicaid provisions in the Affordable Care Act led to an increase in coverage coverage gains among American Indians and Alaska Natives and and increased revenue to IHS- and Tribally-operated facilities. ”Reductions to Medicaid, including loss of the expansion, could result in coverage losses for American Indians and Alaska Natives and reductions in revenue to IHS and tribal providers, limiting access to care,” Kaiser found.

In addition to the revenue, health systems have modeled the procedures and funding on the 2010 law. If it were struck down there would be nothing to replace the revenue or the health care procedures until Congress enacted a new one. That would mean a law that is as acceptable to the Republicans in the Senate, the Democrats in the House, and President Trump.

Just this week Democrats in the House introduced legislation that would expand the Affordable Care Act and add new insurance alternatives for more Americans. That is the opposite direction from the Justice Department’s stand. And many Democrats go even further. Rep. Deb Haaland (D-New Mexico) is a co-sponsor of a bill to expand Medicare to all.

The Republican Party will become “The Party of Healthcare!”

— Donald J. Trump (@realDonaldTrump) March 26, 2019

Indeed, that division in Congress was the crux of the judge’s decision in Texas. He wrote: "In some ways, the question before the court involves the intent of both the 2010 and 2017 Congresses. The former enacted the ACA. The latter sawed off the last leg it stood on."

Speaker Nancy Pelosi (D-California) called the Trump administration’s action an “all out war on the health care of the American people.”

She said: “Democrats will continue to fight relentlessly to protect people with pre-existing conditions and to deliver lower health costs and prescription drug prices for every American.”

Mark Trahant is the editor of Indian Country Today. He is a member of the Shoshone-Bannock Tribes. Follow him on Twitter @TrahantReports.

This story originally appeared on Indian Country Today on March 26, 2019.