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Trahant: Indian country as the 51st state – and short topics

I’ve written a post for Kaiser Health News that advances the meeting with tribes and President Barack Obama Nov. 5. I’ll write something again after the meeting and post it here late Thursday.

The key point I made for Kaiser is that I’d like to see a serious look at the Indian Health Service revenue stream. Everyone in Washington agrees the agency is under-funded. One opportunity to do something about that funding is to streamline the funding from Medicaid, Medicare, and the Children’s Health Insurance Program. IHS was left out of the original Medicare and Medicaid legislation and was not added until the Indian Health Care Improvement Act in 1976. Now the practical problem for Medicaid is its administration by state governments, which have uneven relationships with tribes and Indian organizations.

There ought to be a way to transfer money from one federal agency, the Centers for Medicaid and Medicare, to the Indian Health Service directly. Think of this as cutting waste (always a favorite topic in Washington). Instead of sending money to state programs, there could be a new set of flexible rules written for Native Americans with far less administrative overhead than the 36 different systems. The federal government could treat Indian country, at least for health programs, as the 51st state. Why not a practical application of the nation-to-nation relationship?

Republican objections to including the Indian Health Care Improvement Act in the reform bill

There’s a new interest in the Indian Health Care Improvement Act. House Democrats are now including the act as an amendment to the larger health care reform proposal. But Republican leaders are crying foul.

Doc Hastings, the Ranking Republican on the House Natural Resources Committee, sent a letter to Chairman Nick Rahall objecting to the process. “There is bipartisan agreement on the need to reauthorize the Indian Health Care Improvement Act, and that’s why it is so deeply troubling that the Democrat Majority’s promises of transparency and openness have been violated in this manner,” Hastings notes. “I’ve no doubt that the advocates of reauthorization are encouraged by action, for there is finally movement on legislation that Speaker Pelosi has refused to allow on to the House floor for a vote for over two and half years. Yet, the satisfaction that may be felt today could very well turn into real disappointment in the very near future. Tying reauthorization of the Indian Health Care Improvement Act to the controversial government takeover of the nation’s health care does a serious disservice to tribes and individual Indians and Alaska Natives across the country. Reauthorization should be permitted to move independently and not be tied to such a costly and controversial measure.”

Where were these voices when the Indian Health Care Improvement Act was languishing for a decade? Especially when the Republicans controlled Congress and the White House? More important: The folks who are now warning about a government takeover in health care were saying the same thing with the expansion of the Children’s Health Insurance Program – a source of revenue that was a significant and direct benefit to the Indian health care system.

Mark Trahant is a Kaiser Media Fellow examining the Indian Health Service and its relevance to the national health care reform debate. He is a member of Idaho’s Shoshone-Bannock Tribes. Comment at www.marktrahant.com.