"Passing health care reform was easy. Sure it was a legislative mess: It was too slow, too fast, too many pages and too short on specifics, too open to the influence of special interest lobbies – and too secretive, partly because the language was so complicated and difficult to translate into a simple narrative. Yet enacting health care reform was easy. Executing on real reform, now that’s a challenge.

It’s the same in Indian Country. The Indian Health Care Improvement Act is included as a section of the Patient Protection and Affordable Care Act. But this is only one item to check off on a long to do list, not the goal itself. The next steps are just as important as the law itself: Producing regulations that put the policy choices into action, funding by Congress to make the law work, and execution of the law by the employees of the Indian Health Service, the federal government, as well as by tribes and provider organizations.

The irony of this is how the media covers this issue. The fight over the law was news. It was a big story by any measure. However the equally important debate about health care regulations and the government’s execution of the law will probably get about one-tenth of the coverage. It’s harder to explain.

But one contest that is getting attention: The litigation by 20 states and other groups challenging the health care reform law. Washington Attorney General Rob McKenna recently posted this explanation about why he’s pressing the case: First, the “unprecedented requirement that individuals lacking health insurance must purchase private insurance or face a financial penalty” and, second, because reform represents a “massive expansion of the Medicaid program, requiring states to spend billions more on this program at a time when state budgets are already in crisis.”"

Get the Story:
Indian Health is not included in legislative or legal challenges to health care reform law (Mark Trahant 5/17)

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