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Repeal Health Care Law? Again? So Now What?

The U.S. House of Representatives has scheduled a vote Thursday to repeal the Affordable Care Act.
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The U.S. House of Representatives has scheduled a vote Thursday to repeal the Affordable Care Act (including the permanent authorization of the Indian Health Care Improvement Act). House Majority Leader Eric Cantor, R-Virginia, tweeted: “It just keeps getting worse. I am scheduling a vote for next week on the full repeal of #Obamacare.”

Since the law was enacted more than three years ago, House Republicans have voted more than 30 times to repeal part or all of the law. And, perhaps, more important, Republicans in Congress have tried to pull every lever they can think of to make sure the current law is neither executed nor fully-funded. The goal of Republicans in Congress is to make the Affordable Care Act “worse.”

Mark Trahant

But the problem for Republicans (and in a different way for supporters of the law) is that Americans are confused. Polling last month by the Kaiser Family Foundation showed that four in ten Americans, or 42 percent, are unaware that the Affordable Care Act is the law. Some 12 percent think it was repealed. Another 7 percent say the Supreme Court overturned the law. And 23 percent have no idea whether the act is still law. Nearly half of those surveyed say they “do not have enough information about the health reform law to understand how it will impact their own family, a share that rises among the uninsured and low-income households.”

Then again, it’s no wonder most people are confused by the law. From the moment it passed there has been a misinformation campaign from opponents designed to confuse and stir up distrust.

President Barack Obama said last week that “misinformation” will continue at least through the next election cycle. He talked about the Affordable Care Act last week using Mother’s Day as the reason, saying, “the law is here to stay.” So many people are already better off because of the law, seniors, women, low-income Americans, sick people and families with children. “You're benefiting from it,” he said. “You just may not know it.”

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Indian country, of course, has a unique role in this fight. The Indian Health Care Improvement Act is included in the larger, Affordable Care Act. And, at the same time, the reforms in the Affordable Care Act open up potential funding increases for the Indian health system as well as substantial changes in how business is conducted. So at some point: It would be logical to stop fighting over the law that exists and figure out how to make it work.

But that’s not the game plan for Republicans in the House. As Cantor’s tweet suggests, the only alternative on their agenda is repeal, something that’s not going to happen as long as Democrats run the Senate and the White House.

Republicans in the House are essentially arguing for the system that is currently in place (one that everyone agrees is an expensive mess). So they fight against any of the reforms in the Affordable Care Act, including the ones that save money, such as the Independent Payment Advisory Board (a body designed to help cut costs).

But this entire fight puts Indian country in a difficult political position. The president’s budget asks for more money for Indian health programs. “If the proposed budget is enacted, the IHS discretionary budget will have increased 32 percent since FY 2008,” according to the agency’s news release. Many individual members of Congress – including those who serve on appropriations committees – continue to support these increases for IHS. But because of the larger opposition to the Affordable Care Act, and the broken budget process, it’s unlikely that this budget will become law.

What’s more there are lots of questions about the Indian health system that can only be answered by funding and execution of the Affordable Care Act. For example: Will tribal governments participate in exchanges? Will individual American Indians and Alaska Natives? At the state level? Or in a national exchange? What about the growing disparity for those states that refuse to expand Medicaid? (My solution has long been for Medicaid to treat tribes as states, lifting the problem out of the states entirely.)

But these questions will have to wait for answers. At least until the next election or even the one after that. Meanwhile on Thursday the House will again vote to repeal ObamaCare. But it will still be the law and House Republicans will still work hard to make that law fail.

Mark Trahant is a writer, speaker and Twitter poet. He lives in Fort Hall, Idaho, and is a member of The Shoshone-Bannock Tribes. Join the discussion about austerity. A Facebook page is open at: