Republicans who serve in the House or the Senate should be asked a simple question: How would you fund the Indian health system?
THIS IS TRAHANT REPORTS.
WHY THAT QUESTION? Because the Affordable Care Act, or Obamacare, is a mechanism that has added new dollars to many tribal, nonprofit and Indian Health Service clinics and hospitals. So without Obamacare, it’s important to find out just what is the alternative?
Thursday night the Senate voted to repeal the Affordable Care Act using the budget reconciliation process. The House will have to agree to the amendments and then it will be sent to President Obama. He’s already promised a veto.
But this is a presidential election year. So the next president, possibly, a Republican, would be in position to sign such a bill into law.
That makes the Senate action real — and repeal discussion ought to start, with, how would you take away insurance coverage from millions of people?
To my way of thinking: Medicaid expansion has been the most successful provision of the Affordable Care Act. A recent study by the Centers for Disease Control found that “the number of uninsured persons continued to decline from 2013. In the first 6 months of 2015, 28.5 million persons of all ages (9.0%) were uninsured at the time of the interview—7.5 million fewer persons than in 2014 and 16.3 million fewer than in 2013.”
The law is working.
The Indian health system has a lot of money at stake in this debate.
The Indian Health Care Improvement Act is a chapter in the Affordable Care Act. So a repeal, depending on the language, could end many initiatives funded through that law.
Alaska’s Lisa Murkowski voted for the repeal (even though she had expressed concerns about the provisions in the bill to strip funding from Planned Parenthood). Yet in her statements on the Senate floor, and in a recent op-ed, the senator explained why she is against the law without so much as a single line about its impact on healthcare for Alaska Natives.
Alaska does have a special problem with the Affordable Care Act because of high premiums. And that’s worth fixing. But Alaska also has much to gain from the law, especially the expansion of Medicaid and new funding streams for the Alaska Native health care system. So the logic must be: In order to fix one problem we should make things worse?
The vote Thursday night was absent any discussion of Indian health. It’s as if Republicans hope no one will notice that the Affordable Care Act includes the Indian Health Care Improvement Act.
In an ideal world, Republicans would offer this alternative to Obamacare. They could say the United States will directly fund treaty obligations as an entitlement without requiring insurance or other bureaucratic steps. Now that would be a real answer to the question.