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Mark Trahant: Indian health system is on the ballot this election

Why Indian Country needs the Affordable Care Act in one chart: Spending on Indian health has been historically underfunded. The Affordable Care Act makes it easier for Medicaid and insurance money to boost resources at local Indian health clinics and hospitals. Source: Past, Present, and Future Threats to American Indian, Alaska Native Health by Donald Warne, MD, MPH, and Linda Bane Frizzell, PhD

One election issue that’s troubling involves the Affordable Care Act (or as some would call it, Obamacare). There should be a debate about health care, but it ought to focus on facts and choices, not slogans.

So here is what is occurring across the country: In nearly every state that’s implemented the Affordable Care Act as designed, the law is doing well. There have been serious glitches — Oregon is an example of that — but far more people are covered by health insurance both through their work and through programs such as Medicaid.

On the other hand, states that refused to implement the law are finding that health care coverage, and by extension, access to doctors is becoming more expensive and difficult. The Washington Post recently called this “the Red-Blue divide.” Jason Millman wrote that The Hospital Corporation of America, which has facilities in 20 states, saw “a big gap in Medicaid and uninsured admissions between expansion and non-expansion states.”

We need more data, but it’s clear the Indian health system is experiencing the same sort of Red-Blue divide; roughly half of all those who use the Indian health system live in states that are not expanding Medicaid yet, creating a funding gap. (States set policy for Medicaid even though the federal government picks up all the cost for American Indians and Alaska Natives. And money from third parties, either private insurance or Medicaid, boosts resources at local clinics and hospitals.)

Let’s bring this back into the politics of the Affordable Care Act. There is a strong case to be made that the law is working better than expected (except in states that won’t play along). Yet the law remains unpopular (even if not a big voting issue next month). So the discourse from the Republicans continues to be about repeal. But then what? This is a question that’s hugely significant to Indian Country because there is not an alternative.

In Alaska, for example, I asked Republican Senate candidate Dan Sullivan how Alaska’s Indian health system would get more resources without the Affordable Care Act. He gave a non-answer, but added, “I don’t think a great model exists for Obamacare. I was one of the attorneys general who sued to stop Obamacare.”

Here are the facts: The Affordable Care Act opens up a funding stream for the Indian health system that represents new money through insurance. That money remains in local clinics and hospitals to improve care.

And if the Affordable Care Act is repealed, there is no alternative. None. But the Indian health system will face massive budget cuts over the next couple of years. Right now the Indian Health Service budget is part of the Ryan-Murray budget deal, but that plan expires in 2015 and beginning in 2016 the sequester will again kick in, deeply cutting domestic spending under the Budget Control Act until 2021.

Let’s pull back the lens, a bit. The overwhelming evidence is that the Affordable Care Act is working. It’s not perfect legislation, but it’s far better than the chaos that was in place before the law. Recently Health and Human Services Secretary Sylvia Mathews Burwell and Jason Furman, the chairman of the White House Council of Economic Advisers, said the data should be convincing more states that it’s time to expand Medicaid.

“Because of the Affordable Care Act,” Ms. Burwell said in The New York Times, “we project that hospitals will save $5.7 billion in uncompensated care costs this year. Hospitals in states that have expanded Medicaid are projected to save up to $4.2 billion of the total amount.”

Yet that success has yet to be a part of this season’s political debate. Even in Indian Country. If you look at funding prospects for the Indian health systems, then the Affordable Care Act is the only route that leads to more funding. Sure, it’s worth debating what we want in a health care system — and elections are the right time for that — but going back to chaos? Get serious.

No matter how it’s framed, let’s be clear about this election because Indian health is on the ballot.

Mark Trahant holds the Atwood Chair at the University of Alaska Anchorage. He is an independent journalist and a member of The Shoshone-Bannock Tribes. For up-to-the-minute posts, download the free Trahant Reports app for your smart phone or tablet.

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