indianz.com your internet resource indianz.com on facebook indianz.com on twitter indianz.com on Google+ indianz.com on soundcloud
phone: 202 630 8439
Kill The Tobacco Master Settlement Agreement
Advertise on Indianz.Com
Home > News > Headlines
Print   Subscribe
Mark Trahant: Obamacare replacement faces narrow path to becoming law

Filed Under: Health | Opinion | Politics
More on: 115th, aca, alaska, anthc, donald trump, h.r.1639, house, ihcia, ihs, lisa murkowski, mark trahant, medicaid, republicans, senate, tom cole
     
   

The Alaska Native Tribal Health Consortium manages the Alaska Native Medical Center in Anchorage, Alaska. Photo: ANMC

House bill skips Indian health care; but has narrow path to actually become law
By Mark Trahant
Trahant Reports
TrahantReports.Com

I wrote a couple of days ago that the House bill doesn’t mention a word about the Indian Health Care Improvement Act. True enough. Because, it turns out, the proposed replacement for Affordable Care Act is not a complete repeal. The current law would remain intact.

“The two proposed bills do not repeal the ACA. They leave in place the ACA’s titles affecting Medicare, quality of care, program integrity, biosimilars, workforce reform, the Indian Health Service—indeed virtually all of the ACA except for its insurance affordability provisions, individual and employer mandates, taxes, and Medicaid reforms,” writes Timothy Jost in the journal Health Affairs.

This idea is important. Instead of a repeal, the Republican leadership took the framework of the Affordable Care Act. Then the House authors wrote adjustments to Medicaid spending, the way the bill is paid for, how people get help to buy insurance, and along the way added a few gold coins for insurance company executives. (Compare the bills here in this Kaiser Family Foundation graphic.)

I like the way Jim Roberts described the process on his Facebook page: “Take the ACA, tear out the pages that have been repealed, and see what’s left on the table. Its pretty easy to figure out. Its like cutting the face of an ex-spouse out of the family photos! The entire family photo is still intact and everyone knows who that cutout is. Its Obamacare … You can cut Obama out of the picture, but guess what people, He’s still there!” Jim Roberts is a Senior Executive Liaison for Intergovernmental Affairs at Alaska Native Tribal Health Consortium and a long time expert analyst on how health care policy impacts Indian Country.

So this is the problem I have writing about the bill. Do you go into detail about how bad it is? I could easily type 10,000 words just on Medicaid. Or is it better to focus on the politics, because the odds of this package becoming law are slim. That’s where I headed.

Here is the short version of the politics: Two committees have moved the legislation forward through the House. The House Budget Committee will consider the bill before it goes to the full House for a vote. Then, if the House has enough votes, on to the Senate for consideration.

The Republican Party is divided by serious differences of opinions about health care reform and the nature of government. Conservatives do not believe that health care is a right. They see it as an individual responsibility (Or say they do. If they really believed that, we’d get rid of the employer-based system that insures most people. But that’s another story). This group wants Planned Parenthood defunded. It doesn’t even like the idea of insuring family planning of any kind.

On the other side of the divide are practical Republicans who represent states that have made progress insuring more people because of Medicaid expansion. This group of legislators, mostly in the Senate, see this bill as a way to flip the cost of health care to the states. (Or allow conservative states to do nothing.) The House plan would keep Medicaid running sort of as is between now and 2020 and then turn it into a capped program.

The National Indian Health Board says the House bill would keep in place the 100 percent federal reimbursement to states for American Indians and Alaska Natives patients who use the Indian health system.

One huge problem with capping Medicaid cost is that it works backwards: Because when Medicaid is most needed, such as during a recession, then states have less money available to spend on health care. So people would not get the help they need, when they most need it.

Alaska Sen. Lisa Murkowski spoke at the state legislature about Medicaid last month. According to the Alaska Dispatch News, she said Medicaid strengthened Alaska’s Native health care system and reduced the number of uninsured people visiting emergency rooms.

“So as long as this Legislature wants to keep the expansion, Alaska should have that option,” Murkowski said. “So I will not vote to repeal it.”

At least three Senators have said they would vote no unless Medicaid is protected. And Republicans cannot lose more than three votes in the Senate for the bill to pass. (According to a new report by the Center for Budget and Policy Priorities Alaska would lose the most under the House plan for tax credits, a whopping $10,243.)

Another deal breaker for many members is the nearly unified opposition from the medical establishment. The American Medical Association “is concerned with the proposed rollback of Medicaid expansions, which have been highly successful in providing coverage for lower income individuals. The AMA is also concerned that changes to Medicaid could limit states’ ability to respond to changes in demand for services, including mental health and substance abuse treatment as a result of the ongoing crisis of opioid abuse and addiction.”

The challenge paying for opioid treatment will be a factor because it’s a crisis in so many communities across the country. The House plan leaves this up to the states. Without funding.

Nonetheless President Donald J. Trump is trying to make his first deal. And he is working it hard. He’s trying to get conservatives to support his deal despite their philosophical misgivings.

But if the president gives any more ground, then more moderates will be “no” votes. Trump’s strategy seems to be daring conservatives to vote no. He will demand a party-line vote and say, basically, this is the best deal conservatives are going to get.

It’s also why the president and House Speaker Paul Ryan are trying to move fast. Every day they wait, the opposition has more resources to counter that strategy.

Here is what to watch for in the days ahead. Will conservative interest groups such as Heritage Action, Club for Growth, and Americans for Prosperity, “score” the vote? That’s a record that groups use to rate how conservative are members of Congress. Going against this vote could mean less money, support in primary elections, and less conservative street cred.

Meanwhile Rep. Tom Cole, R-Oklahoma, has introduced a just-in-case bill to reauthorize the Indian Health Care Improvement Act. That measure will be ready in case Congress repeals the Affordable Care Act outright (which is what the conservatives argue is the back-up plan).

Stay tuned.


Copyright © Indianz.Com
More headlines...
Stay Connected:
On Facebook

On Twitter

On Google+

On SoundCloud
Local Links:
Federal Register | Indian Gaming | Jobs & Notices | In The Hoop | Message Board
Latest News:
Supreme Court hands defeat to tribal interests in sovereignty case (4/25)
Matthew Fletcher: 'Gamesmanship' brings defeat in Supreme Court (4/25)
Supreme Court relists petition in Gun Lake Tribe gaming land case (4/25)
Southwestern Indian Polytechnic Institute team wins NASA prize (4/25)
Former top Bureau of Indian Affairs official joins Washington firm (4/25)
Native Sun News Today: Groups fight uranium mining in Black Hills (4/25)
Cronkite News: Budget deadline falls on Donald Trump's 100th day (4/25)
Mary Annette Pember: Indian Child Welfare Act heals our families (4/25)
André Cramblit: Tribes must make language survival a top priority (4/25)
Pojoaque Pueblo loses big decision in gaming dispute with state (4/24)
Supreme Court takes no action on long-running tribal land case (4/24)
Yakama Nation landowners see $68M in Cobell buy-back offers (4/24)
Tim Giago: Sovereignty at risk with Donald Trump in White House (4/24)
Mark Trahant: Donald Trump & Republicans can't seem to govern (4/24)
Native Sun News Today: Chickasaw citizen donates prom dresses (4/24)
Steve Russell: The BEST advertisement for education in America (4/24)
Arlana Bennett: Picking cans with my father became our tradition (4/24)
Terese Mailhot: Maybe some people should be able to play Indian (4/24)
Charles Kader: Tribal communities still face threats to their lands (4/24)
3rd suspect sought in connection with death of elderly Native man (4/24)
Mashantucket Tribe expresses interest in growing industrial hemp (4/24)
Shutdown of federal government looms ahead of April 28 deadline (4/24)
Confederate monuments start coming down as Jackson stays put (4/24)
Blackfeet Nation citizens approve historic water rights settlement (4/21)
Native Sun News Today: Cheyenne River Sioux woman still walking (4/21)
James Giago Davies: Our future is not bleak but bright with promise (4/21)
Rosalyn LaPier: Tradition blends with science in tribal communities (4/21)
Simon Moya-Smith: Media continues to peddle in Indian stereotypes (4/21)
Steven Newcomb: Bill in California dehumanizes indigenous peoples (4/21)
American Indian Library Association battles Trump's big budget cut (4/21)
Navajo Nation citizen faces death penalty for murder of tribal officer (4/21)
Meskwaki Tribe diversifies economy with barbecue sauces and more (4/21)
Aquinnah Wampanoag Tribe must keep fighting despite gaming win (4/21)
Native Sun News Today: Body of missing Cheyenne River man found (4/20)
Ivan Star Comes Out: True tribal histories are concealed in America (4/20)
Steve Russell: Thoughts about sovereignty and tribal governments (4/20)
Dwanna Robertson: Dispelling a common myth about tribal gaming (4/20)
Whiteclay liquor stores ordered to shut down after losing licenses (4/20)
Cherokee Nation blames pharmaceutical industry for opioid crisis (4/20)
Eastern Cherokee citizens back chief amid call for impeachment (4/20)
North Carolina woman punished for abducting Cherokee children (4/20)
Ramapough Lenape Nation denied permit for anti-pipeline camp (4/20)
Ho-Chunk Nation remains confident as rival tribe sues over casino (4/20)
Nottawaseppi Huron Band invests casino funds in unique project (4/20)
Pechanga Band reaches midway point of $285M casino expansion (4/20)
More data needed to address human trafficking in Indian Country (4/19)
more headlines...

Home | Arts & Entertainment | Business | Canada | Cobell Lawsuit | Education | Environment | Federal Recognition | Federal Register | Forum | Health | Humor | Indian Gaming | Indian Trust | Jack Abramoff Scandal | Jobs & Notices | Law | National | News | Opinion | Politics | Sports | Technology | World

Indianz.Com Terms of Service | Indianz.Com Privacy Policy
About Indianz.Com | Advertise on Indianz.Com

Indianz.Com is a product of Noble Savage Media, LLC and Ho-Chunk, Inc.