Health | Opinion

Mark Trahant: Indian health care a GOP target in the new Congress

Monday, January 3, 2011

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 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 healthcare 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.

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.