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‘What Would We Do Without Indian Health Service?’

With Trump’s plan to repeal the Affordable Care Act and ultimately the IHCIA, where does that leave the Indian Health Service?

A lot of tribal people I’ve been talking to lately believe that the Indian Health Care Improvement Act is in peril (that includes the Indian Health Service) because it is intertwined with the Affordable Care Act. They say, “Do you know what would happen if the Trump administration pulls that funding?” The National Indian Health Board was quoted in USA Today last week warning that it would be catastrophic.

People I know who work for the Indian Health Service are nervous that the Trump team might even go so far as trying to eliminate all funding for the Indian Health Service – which provides health care services to 2.2 million people. Many are worried about their jobs. Although we like to poke fun at Indian Health Service sometimes, and there are certainly legitimate gripes about the care provided by our Indian clinics and hospitals, the question we have to ask ourselves is, “What would we do without Indian Health Service?”

Some Native people are fortunate enough to have private insurance to cover their health care needs, but nearly all of us have loved ones who do not, and there is a huge reliance on Indian Health Service. The Indian Health Care Improvement Act made Indian Health Service more effective because the agency has been historically underfunded and, in my estimation, that will continue – especially under these new circumstances. We’ve got to stick together on this issue.


Trump will not recognize tribal sovereignty, treaty rights, or self-determination; much less Native peoples guaranteed rights to health care. That is a given. But, we have allies in Congress and we must increase our efforts to reach out to them and have them become our lobbyists on Capitol Hill to ensure that Native people are not adversely affected by repeal of Obamacare.

On January 11, U.S. Senator Tom Udall (D-NM), Vice Chairman of the Senate Committee on Indian Affairs, offered an amendment to protect against cuts to health care for Indian country. He opposes repealing the ACA, and his amendment would protect health care for Indian country by effectively exempting the Indian Health Service and other tribal health providers from Medicaid cuts if Republicans succeed in repeal. The amendment did not pass, but there will be other opportunities down the road to get it passed.

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An important component of the Indian Health Care Improvement Act is it allows Indian Health Service to get reimbursed from patients who have Medicaid.

"The Medicaid expansion under the Affordable Care Act has helped to fulfill our federal government's trust responsibility to provide health care to tribes," Udall said. "Any reduction in federal payments to the Indian health system would jeopardize the lives and well-being of American Indians and Alaska Natives.”

“The Medicaid expansion has enabled Indian Health Service to provide critical, life-saving services like surgeries and preventative care, and attempts to strip away these services from tribal communities by repealing the Affordable Care Act are unconscionable,” He continued. “My amendment is essential for protecting the health care of American Indians and Alaska Natives against reckless repeal efforts."

Udall’s measure is cosponsored by Senators Martin Heinrich (D-NM), Maria Cantwell (D-WA), Al Franken (D-MN), Heidi Heitkamp (D-ND), Patty Murray (D-WA), Brian Schatz (D-HI), Jon Tester (D-MT), and Ron Wyden (D-OR). The amendment is also supported by the National Congress of American Indians, the National Indian Health Board, and the National Council of Urban Indian Health.

This is one part of the fight. We also need to fortify ourselves, our own health, and educate our families and fellow tribal members. Now is the time to stand strong and stand up to the bully. The Trump administration will be coming after us from all directions, and will probably try to take away our federal recognition and sovereignty as well. Don’t be surprised.

Let me ask you this: What is more important: protecting our water and our sacred lands or fighting for our health care rights? Of course they are connected, but only part of a much larger takeover that we, as Native people, need to study. The rich get richer, and the poor get poorer. That’s true no matter who the President is. Us poor ol’ Indians are known as the poorest of the poor.

Water is life and so is good health care treatment for those who need it, especially our elders. I’m not advocating for one over the other. They are both equally important. I’m simply saying we need the same spirit of Standing Rock when it comes to protecting our health care services. Aho.