Native Health Care at Risk
Tanya H. Lee
Rep. Tom Price, R-Ga., is President-elect Donald Trump’s choice to head up the U.S. Department of Health and Human Services, the agency that oversees the Indian Health Service. As wide disparities in Native health outcomes persist and the IHS continues to struggle to provide quality care, according to a GAO report released just days ago, this choice has Indian country worried.
Price is an orthopedic surgeon. He chairs the House Budget Committee and sits on the Ways and Means Subcommittee on Health, which oversees Medicare. His website describes him as “the quality source for Republican health care policy.”
Repealing the Affordable Care Ac
Price’s first order of business as head of DHHS, in keeping with Trump’s campaign rhetoric, would likely be to help convince Congress to repeal the Affordable Care Act. The ACA provides health insurance to 20 million people who did not have insurance before it was implemented and offers new coverage options for 500,000 American Indians and Alaska Natives, according to DHHS.
Price has repeatedly introduced legislation to repeal and replace the ACA (aka “Obamacare”), in addition to voting for myriad other legislative efforts that would have crippled or dismantled the program.
Repealing the ACA makes no sense to Wehnona Stabler, who is retired from the IHS and now serves as CEO of the Omaha Tribe of Nebraska’s Carl T. Curtis Health Education Center. “At IHS, we spent a lot of money trying to get people enrolled in the health insurance plans [made available through the ACA]. On the tribal side, we’ve done the same for people that may not qualify for Medicaid. The ACA has maybe not been the landslide they told us it was going to be at the beginning, but it has been effective for many people who do not qualify for Medicaid, like the working poor that we serve. It has helped some of our Native people get good insurance for themselves and their family,” she said.
“Why would you want to take that away from the people that are the poorest of the poor in our country?” Stabler asked, noting that repealing the law would be even more devastating for people that, unlike Native Americans who can at least theoretically get care from IHS, have no other options.
Repealing the ACA, however, would have even more serious consequences for Indian country if it means repealing the authorization of the IHS contained in the law, says Cherokee Nation Principal Chief Bill John Baker.
“It would not only be devastating for Indian country, it would be devastating for America. The Cherokee Nation had over 1.2 million patient visits last year. If suddenly there was no IHS, no reauthorization, dumping 1.2 million patient visits on the infrastructure of the state of Oklahoma, many without any payer source whatsoever, would cripple our health system, and we’re just one tribe that had 1.2 million patient visits. You go across Alaska, and New Mexico, and Arizona, Florida, it would have a devastating effect not only on jobs but health outcomes. It would overload the non-Native [health] systems [in a way] that would be hard to come back from,” he said.
Phyllis Davis, a Gun Lake Band Pottawatomi Tribal Council member and chair of the Great Lakes Tribal Health Board, said: “My hope is that through consultation with DHHS’s Secretary’s Tribal Advisory Committee that we would be able to continue to educate the new administration on a potential carve-out for the Indian Health Care Improvement Act if there is a dismantle of the ACA.”
Details of Price’s Health Plan
Based on legislation and policies that Price has supported in the past, he would likely advocate replacing the Affordable Care Act (ACA) with:
- A tax credit of $100 (ages 18 to 35) up to $250 (over age 50) per month per person to help pay health insurance premiums. The tax credit rises with age, but is not adjusted for income; it would be a reimbursement for premiums already paid, not money available to help pay those premiums in the first place.
- Expansion of health savings accounts, which allow people to pay medical expenses with pre-tax dollars. This is a tax shelter for those who can take advantage of it, but useless for people who are living paycheck-to-paycheck and cannot save money.
- A guarantee that people can buy health insurance for a pre-existing condition only if they had health insurance for at least 18 continuous months prior to buying the new policy. People who did not have insurance, or who had to let their insurance lapse, would have to wait up to 18 months to be covered for a pre-existing condition to be covered and insurers could raise their premiums 50 percent a year for up to three years.
- A provision that states get federal grants to set up pools for high-risk patients, an idea that has been tried before and has generally failed.
Under the ACA, health insurance policies cannot have annual or lifetime limits on the dollar value of benefits and they must provide free preventive care, all provisions that could be lost under Price’s plan.
Price is a fervent opponent of abortion and has voted to ban the procedure several times. He favors “defunding” Planned Parenthood, even though medical facilities are already prohibited from using federal funds for abortions. There is no federal allocation of money to Planned Parenthood—the federal money it gets comes through reimbursements for Medicaid and Title X services. Defunding the organization would mean blocking those payments, so the 2.5 million low-income people who rely on Planned Parenthood for their health care would not have access to services including cancer screenings, such as Pap smears and mammograms, HIV testing, STD screening and treatment, education and contraception.
Medicare and Medicaid
Price has advocated giving Medicare recipients vouchers so they would pay directly for health care. He has backed reducing Medicaid costs by giving states block grants and limiting federal oversight of how those dollars are used. “Does that mean organizations would have to compete for this money? Would we be competing against Charles Drew, the black health center in Omaha?” asked Stabler.
Wealth in Washington
Trump’s cabinet could end up being the wealthiest in history, and Tom Price would fit right in. Roll Callputs Price’s net worth at $7.28 million in 2014, making him the 50th (out of 535) wealthiest member of Congress and well insulated from having to worry about how to pay his own family’s health insurance premiums.
According to Roll Call, Price has $5.52 million in investments. A report by the Wall Street Journal raised questions of conflict of interest and insider trading about those investments, pointing out that Price had actively traded more than $300,000 in health-related stocks over the past four years at the same time as he was voting on legislation affecting the healthcare industry. The 2012 Stop Trading on Congressional Knowledge (STOCK) Act forbids members of Congress from using “any nonpublic information derived from the individual’s position…or gained from performance of the individual’s duties, for personal benefit.”
Democratic Sens. Chuck Schumer (N.Y.), Patty Murray (Wash.) and Ron Wyden (Ore.) have called for an investigation into Price’s investments and stock holdings by the Office of Congressional Ethics before his confirmation hearings, the first of which is scheduled for January 18.
Medical Organizations Speak Out
The American Medical Association issued a statement on November 29 supporting Trump’s pick of Price to run DHHS, characterizing him as “a leader in the development of health policies to advance patient choice and market-based solutions as well as reduce excessive regulatory burdens that diminish time devoted to patient care and increase costs.”
But just two days later, more than 4,800 individual physicians, acting under the rubrik Clinical Action Network, protested in a post on Medium, saying that by endorsing Price “the AMA has reneged on a fundamental pledge that we as physicians have taken—to protect and advance care for our patients.”
Then on January 2, four medical organizations representing nearly 400,000 physicians and medical students called on Congress to ensure any health care reform they might enact not increase the number of people who are uninsured. The American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians and American Congress of Obstetricians and Gynecologists also urged lawmakers to keep in place policies that ban lifetime caps on benefits, gender discrimination, and imposing restrictions on coverage for pre-existing conditions, all key provisions of the ACA.
What the Future Holds
“My feeling is we’re going to have to hang on to what we have very tightly and probably work very hard to make any forward movement. I’m serious. I am very worried,” Stabler said. “The overarching priority I hope he has is that he will uphold those treaties and those agreements that were made before he came.”
Baker agrees, but is more optimistic. “Congressman Price is a physician. He knows the ins and outs of health care and clinical situations. I would just truly hope that he would recognize the trust responsibility that IHS has to the Native people all across America,” he said. Regarding repealing the ACA and its provisions regarding Indian health care, Baker said, “At the end of the day, I think cooler heads will prevail.”
One Native American public health worker in Indian country, when asked if she had any thoughts about Price’s nomination, perhaps sums up what many of the people caring for patients today feel.
“I don’t,” she says. “I am a federal employee and I am going to support leadership, whoever is in that role. There’s too much work to be done is how I look at it. There’s too much work to be done for me to waste time doing anything but supporting what needs to happen in Indian country in public health.”
Rep. Price declined to be interviewed for this story.