Why did the U.S. Senate fail to repeal Obamacare? Two Republican Senators, Susan Collins of Maine and Lisa Murkowski of Alaska, were clear from the beginning of the debate that they did not want to see Medicaid destroyed. Then, last week, Arizona Sen. John McCain walked to the floor of the Senate and gave his thumb’s down. McCain was a no vote when it counted.
This is Trahant Reports.
Republicans have campaigned against “Obamacare” for seven years. Yet there was never an alternative that had support from a majority of their own party.
Many (but not all) Republicans see health care programs that help people as welfare. This includes: the Affordable Care Act, Medicaid, even Medicare. Other Republicans look at the evidence and see these programs as effective: insuring people, creating jobs, supporting a rural economy, and actually resulting in better health outcomes.
Of course Indian Country is squarely in the middle of this debate.
Congress has never even considered, let alone acted, to fully fund Indian health programs. But the Affordable Care Act basically defined the Indian Health Service (and tribal, nonprofit, and urban operations) as health care delivery vehicles. And one way to pay for that delivery was by providing health insurance through an expanded Medicaid, no-cost insurance that tribal members could get through exchanges and employers. The ACA with all its faults sets out a plan to fully fund the Indian Health Service.
That’s the challenge now. Making sure that every American Indian and Alaska Native has insurance of some kind. Because of what happened (or, more accurately, what did not happen) in the Senate last week the money remains on autopilot. If you are eligible, the funding is there.
Seven years ago, when I started writing a lot about health care, I did so because I saw the Indian Health Service as a fascinating example of government-run and managed healthcare.
But I was way wrong. IHS is no longer only a government-run system. Much of the agency is now a funding mechanism for tribal, nonprofit, and urban operations). And that’s where so much of the innovation and excellence in Indian health exists. We need to more more about what’s working and why. Yet Congress (and the public narrative) continue to think of an IHS that no longer exists.
This might be a moment to focus on the latter part of what the agency does, improving the flow of funds, and adding more of our people to insurance rolls. Indian Health programs can be fully funded — even in the era of President Donald J. Trump.
I am Mark Trahant.