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.

Republican Party unity on the issue of a massive restructuring of Medicare and Medicaid (if there is such a thing) ended this weekend. Presidential candidate and former House Speaker Newt Gingrich said on NBC’s Meet the Press that he opposed the House budget proposal designed by Rep. Paul Ryan, R-Wisconsin.

“I’m against Obamacare, which is imposing radical change, and I would be against a conservative imposing radical change,” Gingrich said. “I don’t think right-wing social engineering is any more desirable than left-wing social engineering. I don’t think imposing radical change from the right or the left is a very good way for a free society to operate.”

I take issue with the notion that the Affordable Care Act is “left-wing” social engineering. To my way of thinking it’s just a baby step toward the type of reforms that are required by the country’s changing demographics. A radical left-wing solution would be single-payer health care system, not one where private doctors and insurance companies are guaranteed profits from the individual mandate.

But the country also needs a real debate about the hard reality of demographics – there are more seniors than ever, plus we all live longer – and it’s those facts that call for some sort of radical restructuring of Medicare. At least Ryan’s plan does that, even though I disagree with it. His idea is to essentially protect current seniors, shifting the burden to people my age (just under 55) and to younger workers. But this a really tough issue and there ought to be a consensus solution.

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Tags: Mark Trahant, Medicaid, Medicare, newt gingrich, Trahant Reports

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.

The national budget debate is multi-directional. Most of the story, so far, has centered on this year’s federal spending, basically how to strip dollars from a fiscal year that’s roughly half over. Then, there is the fight over next year’s budget, the one that is supposed to start on Oct. 1. And, at the same time, there is an argument about the role of the federal government and long-term spending promises.

I think of these issues a bit like a line from the movie, Ghostbusters. “Don’t cross the streams,” one of the characters warns. “Why?” asks another. “It would be bad.”

We’re at the point in our story where the streams are crossing. The flash of lights and heated rhetoric make it difficult, if not impossible, to explore the issues with either a methodical or strategic approach. We’re a captive to the budget as a show, played on so many stages.

But underlying the theatrics is a basic truth, that much of the growth of government spending stems from demographics, not out-of-control government agencies. Simply put: We have a large older population asking a smaller younger cohort to pay the bills. The cost of an aging society is not just a problem in the United States, it’s a global trend.

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Tags: Health care, Mark Trahant, Medicaid, Medicare, Trahant Reports

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.

Journalists like me have played the role of Chicken Little for many years. We have written dozens of stories about the consequences of an election, predicting what will happen after Republicans win and fulfill their promises to drastically cut government.

Only very little happened. Sure, there were significant budget cuts and restructuring of programs under President Ronald Reagan, but by and large no president or Congress has yet changed the nature of the federal government.

The fact is we still don’t know if this election cycle (or the next one) will be depart from that storyline. We still don’t know what kind of votes the Republicans can round up to make the really difficult decisions about which government programs are effective and which ones should be scuttled.

Unfortunately the budget cutting game, so far, isn’t being thought through with much precision. The Republican Study Committee, for example, is suggesting eventually rolling back the federal budget to fiscal year 2006 levels. That represents as much as a $2.5 trillion over the next five years. Their plan cuts $100 billion from spending this year, an idea that’s already being dismissed by House Budget boss Paul Ryan (R-Wisconsin).

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Tags: Indian Health, Indian Health Service, Mark Trahant, Medicaid, Trahant Reports

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.

Will Republicans muster enough votes to repeal the health care bill? A Michigan Republican said over the weekend that he sees “significant” bipartisan support for repeal, possibly even enough votes to override a presidential veto.

U.S. Rep. Fred Upton, R-Michigan, said on Fox News Sunday, “If we pass this bill with a size-able vote, and I think that we will, it will put enormous pressure on the Senate to do the same thing.”

An outright repeal, however, requires two-thirds majority in both the House and the Senate. A hurdle that is about as close to impossible as it gets in Washington, D.C.

That’s why the Republican strategy includes three other elements: Investigate, repeal sections and refuse to limit the money needed to implement the law.

“The so-called Patient Protection and Affordable Care Act (PPACA) has been widely criticized by the American public, and for good reason,” Upton wrote last month. “… Real oversight is needed, and the Energy and Commerce Committee will work closely with other committees of jurisdiction to reveal, repeal and replace this law.”

And to use Upton’s phrase, these “so-called” probes already know what they will uncover. As Upton himself put it: “Our investigations will demonstrate the need to repeal this law and replace it with common sense reforms that lower costs and increase accessibility to health care without increasing government.”

But this is where the story gets complicated. Too bad there’s not that same passion for oversight when it comes to the historical underfunding for Indian health programs. Or, in general, what will any of these investigations say about American Indian and Alaska Native health? Will there even be a question about the impact of “reveal, repeal and replace” for Native American communities?

I doubt it.

Yet many Republicans – often with districts with large numbers of American Indian or Alaska Native voters – say they don’t like and will vote to repeal the health care reform law, but they do like the Indian Health Care Improvement Act. New South Dakota Rep. Kristi Noem said as much during her election campaign.

But that logic is flawed: if there is a repeal of the health care reform bill, there also will be a repeal of the “permanent” status found in the Indian Health Care Improvement Act. The two laws are one.

There is no way, politically at least, to repeal health care reform except for the Indian health care provisions (or for that matter, other popular measures, such as relief for the donut-hole in Medicare). This is a simple way of pleasing folks back home that means nothing. There is no exception; there is only a divide between those who would work with this law, complicated as it is, and those that would start over with nothing.

Beyond that stark rhetoric however is a practical question: Will the new Republican majority support stable funding the Indian Health Care Improvement Act? The law is only an authorization to spend money – it must be implemented by an appropriations from Congress.

This is where the seeds of tragedy are being planted. The Republicans are creating a new powerful budget post, chaired by Paul Ryan from Wisconsin. He will have the authority to set a ceiling for federal spending. The spending committees, then, would have to spend below that ceiling. Some Republicans in Congress have promised to roll back that spending as much as 20 percent. Imagine the impact on an already starved Indian health system. (Ryan has also called for abolishing Medicare for those under 55 years old as well as the Children’s Health Insurance Program and Medicaid. All three are key elements of funding the Indian health system.)

Republicans promised a frugal government. If that’s really what they want, then the Indian health system should be fully funded because it’s the most efficient health care delivery system in the country.

But that would require an exception to flawed logic.

Tags: buffalo post, Health care reform, indian health care impro, Indian Health Care Improvement Act, Mark Trahant, Medicaid, Medicare, Trahant Reports

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 new book, “The Last Great Battle of the Indian Wars,” is the story of Sen. Henry Jackson and Forrest Gerard.

President Barack Obama set a high standard for tribal-federal relations last year. “Today’s summit is not lip service,” he said at the summit. “We’re not going to go through the motions and pay tribute to one another, and then furl up the flags and go our separate ways. Today’s sessions are part of a lasting conversation that’s crucial to our shared future.”

That lasting conversation is continuing as promised. It’s remarkable enough for a president and cabinet officers to meet with tribal leaders once during an administration – but this second round means that the standard is now an annual event.

So what should we be saying about our shared future?

I’d use this as an opportunity to prepare for the coming financial storm – serious and long-term budget cuts that are coming from Congress – as a way to reconfigure federal services to Indian Country.

Take Medicaid and Children’s health programs. One of the best ideas coming out of the health care reform process is a feasibility study exploring the treatment of the Navajo Nation as a state. In tough budget times this is huge because state governments want to limit enrollment in Medicaid and Children’s Health Insurance to save money. But eligible American Indian and Alaska Natives do not cost the states money – it’s a 100 percent federal match. By moving the administration to the Navajo Nation, it makes it much more likely that eligible patients will be enrolled in Medicaid or Children’s health adding critical revenue to the Indian health system.

The Navajo Nation feasibility project is only step one. This should be the beginning of a process that singles out other tribes, or regional associations, into administrative units that could manage Medicaid programs without a state roll. Or as I have put it before, treat Indian Country as a 51st state.

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Tags: children's health insurance, Children's Health Insurance Program, Mark Trahant, Medicaid, navajo nations, President Barack Obama, tribal nations summit, tribal-federal government relations

Mark Trahant has spent the past year as 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 and writes from Fort Hall, Idaho. Comment at www.marktrahant.com. His new book is “The Last Great Battle of the Indian Wars,” the story of Sen. Henry Jackson and Forrest Gerard.

What will the Indian health system look like a decade from now?

That’s an impossible question to answer. There is the potential of a court ruling striking down at least part of the Patient Protection and Affordable Care Act. And, there is always the possibility of Congress will rewrite the law (I view this as remote because there would have to be a Super Majority to enact something else.)

But in the meantime there is a new foundation already under construction. The building that will rest on that structure will not be the same as the one in place now.

Let’s start with the patient. Right now, according to the Kaiser Family Foundation, nearly half of all American Indians and Alaska Natives are either uninsured or rely solely on the Indian Health Service. But health care reform changes that. Big time. Beginning in four years, hundreds of thousands of people will become eligible for insurance through government programs (such as Medicaid) because of new income rules. This insurance can be used to pay for services at Indian health system facilities – or at competing health care centers. (Think about how many private walk-in clinics promise no waiting.)

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Tags: Health care reform, Indian Health Service, Kaiser Family Foundation, Mark Trahant, Medicaid, Patient Protection and Affordable Care Act

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 and writes from Fort Hall, Idaho. Comment at www.marktrahant.com His new book is “The Last Great Battle of the Indian Wars,” the story of Sen. Henry Jackson and Forrest Gerard.

A single phrase is often used to define the Indian health system: “Government-run.” Add those two words to any discussion about health care or reform and most people reach an immediate conclusion about the merits of the agency.

Now it is time for the phrase to disappear because it no longer accurately describes the Indian health system. After all, tribes or tribally authorized nonprofit agencies administer more than half of the IHS budget, through the Self-Determination Act or Self-Governance compacts.

Certainly the federal government plays a huge role in this health care delivery system – across the country. “As in all industrial nations, the U.S. government plays a large role in financing, organizing, overseeing, and, in some instances, even delivering health care,” said a report last August by the Robert Wood Johnson Foundation.

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Tags: berdeen Area Tribal Chairmen’s Health Board, Everett R. Rhodes, Indian Health Service, Mark Trahant, Medicaid, Medicare, Oglala Lakota, Patient Protection and Affordable Care Act, Robert Wood Johnson Foundation, Sanford Health, Self-Determination Act, Self-Governance compacts, Western Journal of Medicine

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 and writes from Fort Hall, Idaho. Comment at www.marktrahant.com. His new book is “The Last Great Battle of the Indian Wars,” the story of Sen. Henry Jackson and Forrest Gerard.

WASHINGTON, D.C. – Every agency that serves American Indians and Alaska Natives must answer these questions in order to fuel the decision-making process: How much will it cost? How many people are served? And, by the way, who is an Indian?

None of the answers are easy. The demand for federal services is growing as resources shrink. And in the health care arena the key to sustainable funding is Medicare and Medicaid (including the Children’s Health Insurance Program) where definitions are complicated by multiple factors.

Consider eligibility: More than 560 tribal communities with members living on or near reservations or spread out in urban areas. Each tribe defines its membership but that data is rarely collected for use in health statistics because it’s often privately held. The U.S. Census allows each individual to define his or her own status by checking a box. (Some 5 million by this count.)

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Tags: Alaska Natives, American Indians, buffalo post, Census, Children's Health Insurance Program, Edward Fox, Indian Health Service, Internal Revenue Service, Kauffman and Associates, Matthew Snipp, Medicaid, Medicare, merican Indian Alaska Native Data Symposium, National Museum of the American Indian, Native Americans, Office of Management and Budge, Patient Protection and Affordable Care Act, Squaxin Island tribe, Stanford University, U.S. Census

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 and writes from Fort Hall, Idaho. Comment at www.marktrahant.com. His new book is “The Last Great Battle of the Indian Wars,” the story of Sen. Henry Jackson and Forrest Gerard.

(Material for this column was originally published in December and March.)

Daniel Patrick Moynihan once said: “If you’ve been in government a long time, as I have been, then the most exciting thing you encounter in government is competence. Why is this exciting? Because it’s rare.” When I read the quote, even today, I can hear the late New York senator’s voice booming, his last word full with extra punctuation.

Today, I’m excited for the government. Health care reform should bring nutrition to a starving Indian health system. And, if the next test for health care reform is execution, then the government might be on the right course. President Barack Obama used his authority to give Dr. Donald Berwick a recess appointment to head the Centers for Medicaid and Medicare Services.

This is a choice that exceeds Moynihan’s rareness of competency. Berwick represents the ideal, the one person you think could help the government, the people and the medical profession come together around the idea of excellent health care. Last December, at the Institute for Healthcare Improvement conference I watched hundreds of professionals cheer on Berwick as they would a rock star. This is a doctor who’s willing to talk about what’s really important to people. “Health care has no intrinsic value at all. None, health does. Joy does. Peace does,” he said in December. “The best hospital bed is empty. The best CT scan is the one we don’t need. The best doctor’s visit is the one we don’t need.”

Imagine that. Doctors we don’t need.

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Tags: Alaska Native Medical Center, buffalo post, Centers for Medicaid and Medicare Services, Daniel Patrick Moynihan, Donald Berwick, Garrett Hardin, Health care reform, Indian Health Service, Mark Trahant, Medicaid, Medicare, Native American news, President Barack Obama, Science magazine, Southcentral Foundation, Tragedy of the Commons