Democratic candidates debate full funding for Indian health (well, kinda, sorta)

Mark Trahant

This week 20 Democratic candidates for president will have their first presidential debates; candidates most familiar with Indian issues are not participating

On Wednesday and again on Thursday 20 of the 24 national Democrats running for president will be on a stage debating national issues. (The debates will be hosted by NBC, MSNBC and Telemundo beginning at 9 ET.)

You can bet the legacy news media will tell us who does well -- and how that impacts the standing of each candidate. Who’s up. And who’s not. Who’s the frontrunner. And who is coming up fast. But that kind of reporting misses out on public policy. There is a worthwhile debate to be had about issues and which direction a candidate would take the country.

Especially issues that impact Indian Country.

For example all of the Democrats say they support universal health care. Some have specific plans such as Medicare for all, while other candidates favor a more incremental approach, building on the work of Obamacare.

Medicare is a universal insurance program for mostly elderly people and it spends $10,739 per person. If that were the same across the board, the Indian health system would no longer have to seek a direct appropriation (or could use that money for other things) because the insurance coverage for patients in the Indian health system would exceed $27.5 billion. That’s about a three-fold increase (when you include Medicaid dollars).

This is a national promise for a fully-funded Indian health system.

The question is do any of the candidates know that? They are debating full funding without even thinking through the implications of universal care for the Indian health system. (The phrase Indian health system includes the Indian Health Service, tribal, nonprofit, and urban facilities.)

There is also a secondary debate -- one that impacts us as well -- about continuing to expand Medicaid. How can the federal government encourage more states to expand Medicaid? (Medicaid is a significant, if not the largest, single source of revenue for the Indian health system.)

Jason Smith, Confederated Salish and Kootenai Tribes, and Montana Gov. Steve Bullock. (Photo by Mark Trahant)

Montana Gov. Steve Bullock, who will not be on either debate stage, has spent a lot of time with tribal issues and works with a legislature that has more Native representation than any in the nation. He has real experience with improving the funding of Indian health through Medicaid expansion -- and if he were in the debate would likely talk about that. Bullock convinced conservatives in the legislature to continue the public health insurance (even while GOP legislators in other states are backing away from Medicaid.).

Another candidate who will not be on stage is former Alaska Sen. Mike Gravel. A decade ago Kalyn Free organized “Prez on the Rez” and a forum was held on the Morongo Nation in California. Gravel was a candidate then, too.

Even then he joked about his age (he was only 79 years old then) telling the intertribal town hall. "I know how you honor people my age," he said. "And that's why you will support me."

Gravel promised to free Leonard Peltier, a Turtle Mountain Chippewa, convicted of killing two FBI agents in 1975. President Clinton should have taken care of that, he said.

This time around Gravel is still raising issues that other candidates ignore.

He recently took to Twitter to demand a federal investigation to look into the murder of Clarence Leading Fighter in a northwest Nebraska church. “Shot twice in the doorway of a church by police, after already being tased,” Sen. Gravel wrote.

“It would be easy to laugh at Gravel’s campaign,” wrote Clare Malone in the “But while he’s not likely to win the nomination, Gravel is carrying on a grand American tradition: the protest candidate.”

Turning back to the 20 candidates who are on the stage Wednesday and Thursday, there are so many questions that should be asked.

Here are 10 questions for 20 candidates.

10. Will you support legislation to forward fund critical services so that neither party in Congress (or the White House) can shut down the government?

We all know the impact of a government shutdown on tribal nations. Read more: Congressional hearing looks at the impact of shutdown on Indian Country.

9. How would you make sure that all tribal nations are treated under the law as sovereigns and as equal governments? (Fixing, among other things, the Carceri decision.) Read more: Interior denies Mashpee trust land: ‘You do not meet definition of an Indian’.

Elizabeth Warren
Sen. Elizabeth Warren, D-Massachusetts, speaking at a meeting of the National Congress of American Indians in Washington.(Photo by Jourdan Bennett-Begaye)

8. Speaking of identity: What lessons should we take away from the issues involving Elizabeth Warren, President Trump’s attacks on “Pocohantas,” and tribal identity and citizenship? Read more: Changing Elizabeth Warren's story to one about Native America

7 and 6. How can we make sure that Indian Country is counted accurately in the coming Census and what steps can be taken to make sure that Native citizens are fairly represented in Congress, the courts, and the administration? And, along the same lines, how do we improve the structure and fairness of the election system? Read more: Ask those presidential candidates to fix the mess we call an election.

5. How do we prepare young people, especially those living in rural areas, for the technology of the future? Read more: Preparing Native American youth for a million lines of code.

4. What will it take to make all Americans more healthy, especially Native Americans? The United States promised through treaties to provide health care. What if that promise were fully funded? What would that look like? Read more: Attack on Medicaid is an attack on treaty rights

3. The country (and the planet) is aging like never before. This changes everything. Millions of workers will want to retire, others will work part-time and there will be more pressure on young people to pay for this transition. How should it be managed? Read more: Demographic shift.

2. There are only two choices when it comes to climate change: Mitigation or adaptation. Mitigation is when governments work to slow the rising temperatures brought about by humans. Adaptation is simple: Build higher seawalls, move people to higher ground, places with more water. We know that tribal nations are on the first line of this question. So, twenty candidates, what kind of resources do you think are are required to make a difference in each area? Read more: Tribes lead the way on climate change ballot measure

Washington Gov. Jay Inslee on Monday released his climate action plan, Freedom from Fossil Fuels. The Indigenous Environmental Network said Inslee's plan lays out proposals for tribal nation inclusion, by “directing federal agencies to fully empower tribal nations, through free, prior and informed consent, and the enforcement of treaty rights, to reject major infrastructure proposals that would adversely impact their people, land, water, or cultural resources. And requiring all federal environmental review and permitting processes to involve thorough consultation with and input from local communities.”

Several candidates are co-sponsors, or supporters, of the Green New Deal. An aspirational climate plan that ties economic health with climate policy. On board as co-sponsors: Sen. Bernie Sanders, Sen. Cory Booker, and Sen. Kamala Harris. Supporters include: Sen. Elizabeth Warren, Sen. Amy Klobuchar, Sen. Kristin Gillibrand, author Marianne Williamson, former Housing Secretary Julían Castro and a former tech executive Andrew Yang. 

So expect a lot of conversation about climate change. (But not a full, single topic debate. Yet.)

One. What won't be discussed, is our number one question. How would you, leading this government, live up to the language so carefully included in the U.S. Constitution that codifies treaties as the “supreme law of the land?” In the Obama White House there was a formal annual meeting with tribal leaders. Could that be a part of the conversation, too? And every candidate, for old time’s sake, ought to watch George Bush's take on Sovereignty. 

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Mark Trahant is editor of Indian Country Today. He is a member of the Shoshone-Bannock Tribes. Follow him on Twitter - @TrahantReports