The House of Representatives passed the American Health Care Act by four votes last week. The legislation now moves to the United States Senate for consideration. This bill would dramatically reshape the healthcare system, including Indian health.
This is Trahant Reports.
House Republicans propose doing three things: Cutting taxes (significantly); spending less on Medicaid; and reducing the federal role so that states can experiment more with health care programs.
As I have reported before: The most important idea for Indian Country is that the legislation would end Medicaid as we know it. Medicaid insures more than half of all children in the Indian Health system and it accounts for 13 percent of the Indian Health Service budget.
At least four Republican Senators say Medicaid is a critical safety net that ought to be preserved. A bloc of four senators has the power to say “no” to any legislation. This is the Medicaid Protection Bloc and they will have a say in rewriting the bill.
And no matter what comes out of the Senate (unless it’s the House bill exactly) the House will have to vote again.
Indian Country should be included in this debate. And we’re not. Our right to health care is simple, it’s based on treaties, history, and thus a pre-payment for whatever insurance mechanism the country comes up with. The Affordable Care Act at least opened an avenue to fully fund the Indian Health system, something that’s never been accomplished before.
So this is also the ideal moment for Indian Country to have more of a say.
Rep. Tom Cole, a Republican in leadership, and a member of the Chickasaw Nation, told National Public Radio: “This thing is going to go to the United States Senate. It’s going to change, in my view … Then we have to have a Congress — a conference to work out the differences. If we can do that, then it has to still pass the House and the Senate again before it ever gets to the president.”
Cole is often a champion for Indian health programs, especially when it comes to the budget. He’s usually the only Native American at the table when budgets are written.
Cole has also been against Medicaid Expansion, saying his state, Oklahoma, did not go that route. But this House measure is not just about Medicaid Expansion; it’s a radical restructuring of Medicaid designed to cap costs. Even in Oklahoma Medicaid serves more than 800,000 people. And, remember that Medicaid is 13 percent of the IHS budget, more than $800 million now and growing.
Plus this is the best kind of money because it stays at local clinics and hospitals.
This is what Tom Cole and Republicans in the House voted to take away from Indian Country. And you can be sure: This is what will be on the ballot next year.
I am Mark Trahant.