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Tribal leaders hear dueling messages on Indian health in the new Donald Trump era

National Congress of American Indians President Brian Cladoosby addresses the organization's winter session in Washington, D.C., on February 14, 2017. Photo by Indianz.Com / Available for use under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License

As tribal leaders navigate the nation's new political climate, they are hearing conflicting messages from even some of their closest allies on Capitol Hill.

Indian issues have always been portrayed as non-partisan but a slew of lawmakers confirmed that's not the case, at least when it comes to health care. Republicans and Democrats shared vastly different views on the subject as hundreds of tribal leaders gathered in Washington, D.C., for the winter session of the National Congress of American Indians.

Republicans on the one hand insisted they will protect the gains made in the Indian Health Care Improvement Act (IHCIA) while they pursue a repeal of the Affordable Care Act, popularly known as Obamacare. The IHCIA was included in the larger law and, more significantly, was made permanent after strong lobbying efforts by tribes.

“We need not pull the rug out" on Indian Country, Rep. Doug LaMalfa (R-California), who is serving as the new chairman of the House Subcommittee on Indian, Insular and Alaska Native Affairs, said on Tuesday at NCAI's meeting.

But Democrats offered a different take. They said their colleagues on the other side of the aisle have failed to offer a concrete plan to protect the IHCIA, not to mention the pro-tribal provisions found elsewhere in the national health law.

"Protecting and honoring our trust responsibility means protecting the promise of the Affordable Care Act," Rep. Nancy Pelosi (D-California), the top Democrat in the House, told tribal leaders.

The disconnect comes as lawmakers and tribes alike wait for Republican President Donald Trump to advance his own health priorities. His new administration must propose a fiscal year 2018 budget for the Department of Health and Human Services, which includes the Indian Health Service, but it's not expected for at least another month, or maybe even much longer.

"We should have a new budget by now. All new presidents are cut some slack to get their people in place and send Congress a late budget," Darren Benjamin, a top Republican staffer on the House Appropriations Committee, told tribal leaders. "But everything I read in the press, this looks to be later than anything I’ve ever seen."

Complicating matters is the lack of a fiscal year 2017 budget for the federal government. Lawmakers instead passed a continuing resolution that leaves the Indian Health Service and other tribal programs without any increases despite inflation and rising costs.

"So there's no clarity from Congress ... there's no clarify from the Trump administration," said Rep. Betty McCollum (D-Minnesota), who serves as the co-chair of the Congressional Native American Caucus, a bipartisan group of lawmakers.

The uncertainty has some tribal leaders worried. "A lot of it still leaves us in doubt about our future," Victor Joseph, the chairman of the Tanana Chiefs Conference in Alaska, said of the conflicting messages coming from Washington on the IHCIA and funding for the IHS.

NCAI President Brian Cladoosby expressed similar concerns after he delivered the first State of Indian Nations address in the Trump era on Monday. He said tribes need more than words to feel safe about the health care promised to the first Americans through treaties, agreements and other statutes.

"We've heard that [but] we haven't seen it in writing," Cladoosby said of the pledge to safeguard the IHCIA and the IHS.

Despite the challenges, tribal leaders are counting on allies in the legislative branch to help them deal with the new executive branch. Lawmakers from both parties repeatedly promised to help Indian Country on self-determination, economic development and other issues.

"Meeting our treaty obligations, fulfilling our trust responsibility is not discretionary," Rep. Derek Kilmer (D-Washington) said to applause.

NCAI's winter session, which began on Monday, continues on Tuesday evening with the 19th annual leadership awards banquet. This year's honorees include Rep. Tom Cole (R-Oklahoma), who is a citizen of the Chickasaw Nation and is one of only two members of a federally recognized tribe in Congress. He is among those working to come up with legislation to protect Indian health if Obamacare is repealed.

Wednesday's agenda includes an update from Rear admiral Chris Buchanan, who is serving as the acting director of the IHS. Trump has yet to nominate a leader for the agency although former Rep. Tom Price (R-Georgia) has been confirmed as the new Secretary of Health and Human Services. Price is a fierce opponent of Obamacare.