Senators Tom Daschle, D-South Dakota, Vice President Dan Quayle, and Senator Trent Lott managed the Senate when the numbers were tied, 50/50.
(US Senate photo)
Treasury Secretary Andrew Mellon championed tax cuts for the wealthy — and sharp budget cuts — in the years before the Great Depression. (Treasury Department photo)
The Senate passed its tax bill early Saturday morning. And, it turns out, Indian Country might have been worried about the wrong, Andrew. Andrew Jackson? No. Because the Republican tax plan would make one Andrew Mellon proud.
This is Trahant Reports.
Andrew Mellon was a wealthy industrialist who served as the Secretary of Treasury. President Trump’s own Treasury Department describes his tenure this way: “During the nation’s “most materialistic period in its history Mellon’s philosophy was one of debt reduction, tax reduction, and a balanced budget … His theory was that big business would prosper in proportion to the lightening of its tax load and its profit would be transferred to the rest of the Nation.
The Great Depression blew a hole in that idea. And if history is prologue, well, this all sounds familiar.
Now the House and the Senate have passed legislation to sharply reduce taxes with the idea that business will prosper and transfer its winnings to the rest of the nation.
The conservative wing is honest about this means. They say when the tax cuts result in a massive expansion of debt, they will want sharp budget cuts to follow. This is a core belief. And has been since Mellon’s time.
How bad is the Senate tax bill? It’s right up there as one of the most unpopular bills ever. An average of polling finds support at about one-third of those polled. And, get this, FiveThirtyEight reports that this tax cutting bill is even more unpopular than tax hikes.
A couple of notes about Indian Country: So many tribal citizens are the low end when it comes to earning. This bill does nothing to help. Indeed there was a late night effort to increase tax credits for families with children. It failed because there would have been less money for corporate tax cuts. Nearly half of all Americans don’t pay income tax, it’s the payroll tax that is the burden. So a child credit would have helped ordinary working families.
Instead of turning the dial back on fossil fuels the Senate bill aligns the tax code for more oil and gas development. Alaska Sen. Lisa Murkowski has made this her signature.
This bill also strips the mandate to buy health insurance. A win for freedom, right? Perhaps. But it also means that healthy people will not buy as much insurance leaving sicker, older people to pay the bills.
There are a whole cast of winners: Big corporations, rich would-be heirs (like the Trump children) and religious schools (a last minute amendment by Sen. Ted Cruz expanded tax savings for this purpose).
The fight isn’t quite over: This bill will still have to be reconciled with a House version. But cutting taxes (and then the budget) is something Republicans have championed long before Andrew Mellon. So this bill is likely to become law soon.
I am Mark Trahant.
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.
Republican leaders in the Senate Mitch McConnell (R-Kentucky) and John Cornyn (R-Texas) say a vote on health care will be scheduled early this week. But Senators are unclear about which proposal will be voted on. (Senate photo)
Here we go again. Another week and the United States Senate is ready to vote on legislation to remake the entire healthcare system, including Indian health. The Senate will do this without a draft, public hearings, or common sense.
So what does the healthcare bill look like at this point? I have no clue. Neither do the 100 senators who will make that call.
This is Trahant Reports.
There will be a vote to at least repeal the Affordable Care Act. And perhaps replace it, too. But what the bill looks like is unclear.
Last week the National Indian Health Board, the National Congress of American Indians, and the National Council of Urban Indian Health, wrote that one of the Senate proposals, the Better Care Reconciliation Act of 2017, would change the formula for funding Indian health programs.
The three intertribal organizations called the proposal a “radical departure from over 40 years of federal policy” and it “should not be undertaken without nationwide tribal consultation.” The bill’s language shifts the funding formula for Indian Health Service patients who are funded by Medicaid. This change would take away from the unique incentive for states to work with tribes to create Medicaid innovations that best support the Indian health system. States could create new rules that could even ignore the Indian health system as a partner and create new barriers that would sharply reduce funding.
It would be one more costly strike to an Indian health system that’s already underfunded.
Back to the math:
There are 100 members of the Senate. The 48 Democrats are certain to vote no. And of the 52 Republicans, it’s unlikely Sen. John McCain would leave his cancer treatment in Arizona to vote on a motion to proceed (that’s the opening of the debate and consideration of amendments).
That leaves 51 votes. Sen. Susan Collins of Maine is a certain no. That reduces the number to 50 (and 49 no votes).
There are lots of questions about Senators Lisa Murkowski of Alaska, Rob Portman of Ohio, and Shelley Moore Capito of West Virginia. Capito tweeted: “I will only vote to proceed to repeal legislation if I am confident there is a replacement plan.” Portman said he’ll review whatever bill comes up. Murkowksi has said she is concerned with the process — and the impact of a bill on families.
Does that sound like three no votes? Right now, I’d only count all three as a firm maybe. Then again only one needs to be the “no” vote.
I am Mark Trahant.
The Indian Health Service is Indian Country’s largest employer. Proposals in the House and Senate would significantly cut Medicaid — a program that accounts of IHS jobs. (Trahant photo)
The Senate is back this week and Republican leaders are once again looking for votes for their health care plan. It’s a tough sell for lots of reasons. The bill tips towards conservatives and moderates say no. Rewrite the language so that moderates are happy — and the conservatives bolt. And it only takes three GOP no votes for this bill to fail.
Both the Senate bill, and the House counterpart, are supposed to be about repealing the Affordable Care Act. But for Indian Country there is something else at stake, jobs.
This is Trahant Reports.
Some history. I am not sure of the exact year. It probably happened around 1996. That’s when the Indian Health Service became the single largest employer in Indian Country.
This makes sense when you think about it: Indian health was once a small (unappreciated) division of the Bureau of Indian Affairs. But by 1996 the agency’s budget was larger than the BIA’s — and there were likely more workers. The administration estimates that next year the BIA will have some 6,770 full-time employees while the Indian Health Service will have more than 15,119 employees.
Big numbers, right?
A fast-growing category of jobs is called “healthcare support jobs.” The list here would include Community Health Representatives (long a staple in Indian Country), medical record keeping and coding jobs, as well as different kinds f medical technicians. These can be good gigs in a rural, tribal community.
That’s an area of jobs where Medicaid funding is key and it’s a resource that would go away in both the House and Senate plans.
Alaska is a prime example. More than half of Medicaid spending serves rural constituents. Medicaid covers two-thirds of all American Indian and Alaska Native children and more than one in four of American Indian and Alaska Native adults. The Urban Institute estimates that the kind of block grants found in the Senate’s Better Care Reconciliation Act would cost the state $590 million in federal funding — a number that would decline even sharper after 2025. And, of course, the job losses would be substantial.
Medicaid already directly accounts for 24 percent of IHS’ workforce, but even that is short of the kinds of jobs that serve tribal communities. It does not include school-based programs. Or those private companies that bill Medicaid for transportation of patients or other patient services.
So as the debate heats up this week, remember that the Senate bill is about a lot more than just how healthcare is delivered. It’s also about jobs. Thousands of jobs. I am Mark Trahant.
House and Senate negotiators have reached a deal on a budget resolution. Let’s be clear about this plan: It would require deep spending cuts in federal Indian programs.
The Associated Press reports the spending plan adds some $40 billion to the military and deeply cuts all domestic programs (which would include the Indian Health Service and the Bureau of Indian Affairs).
In past budget years, American Indian and Alaska Native programs have been able to get support from the appropriations committees, but in this cycle, there will be less flexibility because of the instructions in the budget. So Democrats say the Republican budget is both “insufficient and fundamentally flawed.”