Archive for August 15th, 2011

Mark Trahant

Mark Trahant is a writer, speaker and Twitter poet. He is a member of the Shoshone-Bannock Tribes and lives in Fort Hall, Idaho. Trahant’s recent book, “The Last Great Battle of the Indian Wars,” is the story of Sen. Henry Jackson and Forrest Gerard.

It’s a hell of a way to run a country.

Last week a federal appeals court ruled at least one major provision of the Affordable Care Act is unconstitutional. And, at the same time, a congressional Super Committee, led by members who are divided over spending, taxes and basically a vision for the country, will try to reach a deal in the next few months to cut at least $1.2 trillion from federal spending.

And, at the same time, the Obama administration is moving forward with provisions under the Affordable Care Act, awarding some $185 million to states and the District of Columbia to build insurance exchanges. And, again, at the same time, while the law calls for a major expansion of Medicaid, states are cutting back that same program.

Four major health policy alternatives are all moving on separate tracks, in different directions.

The Indian Health system is feeling that pull. How does a tribal government plan ahead? There’s no way to know which direction will ultimately be the course. Imagine taking a trip where the operators are continually switching direction. Go north, no south, no east, now west. Even a kid wouldn’t know better than to ask, “are we there yet?”

The good news for those who support the Indian Health Care Improvement Act is that a panel of the Court of Appeals for the 11th Circuit last week did not strike down the entire Affordable Care Act, only the provision that required Americans to buy mandatory insurance. Indeed, the decision is fascinating because it focuses on whether the mandate is a tax or a penalty. “Even on the government’s own terms, the individual mandate does not in ‘practical operation’ act as a tax,” the court said.

Of course, this is particularly complicated for American Indians and Alaska Natives. We are, supposedly, subject to the individual mandate to buy health care, but are exempt from the penalty.

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