Indian lawmakers support Republican repeal of Affordable Care Act

Rep. Markwayne Mullin (R-Oklahoma) addresses the winter session of the National Congress of American Indians in Washington, D.C., on February 15, 2017. Photo by Indianz.Com / Available for use under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License

The only two enrolled tribal citizens serving in Congress are celebrating with fellow Republicans after a bill to repeal and replace the Affordable Care Act cleared the House in a close vote.

Rep. Tom Cole (R-Oklahoma), a citizen of the Chickasaw Nation, and Rep. Markwayne Mullin (R-Oklahoma), a citizen of the Cherokee Nation, were among the 217 Republicans who supported H.R.1628, the American Health Care Act. The bill passed by just four votes on Thursday afternoon. No Democrats supported it.

“It’s painfully obvious that the Affordable Care Act is not working,” Cole said in a press release. “Premiums have risen through the roof, patient choices have dwindled, and taxes and penalties have increased dramatically. While the legislation we passed today isn’t a perfect solution, it will increase choices, reduce costs, and give consumers greater flexibility.”

“The American Health Care Act takes health care out of the hands of Washington, D.C. bureaucrats and puts it back where it belongs: in the hands of the patients,” Mullin said in his press release.

The White House on YouTube: Remarks on American Health Care Act

Cole and Mullin have voted to repeal the Affordable Care Act, popularly known as Obamacare, in the past but those bills stood little chance of becoming law when Barack Obama was in office. Republicans are hoping the situation changes with President Donald Trump in their corner.

“This has really brought the Republican Party together, as much as we’ve come up with a really incredible healthcare plan,” Trump said in a victory speech at the White House after the vote on H.R.1628.

Both Cole and Mullin have said they have been consumed by the repeal and replace effort since the start of the 115th Congress in January. Their primary goal was to ensure that the Indian Health Care Improvement Act, which was made permanent by the Affordable Care Act, was not affected.

They were successful in that regard. The bill does not change the status of the landmark Indian health law and does not disturb other pro-tribal provisions of the ACA.

The replace portion has been trickier. By halting the expansion of Medicaid and making other changes to the program, tribal advocates are worried that the the Indian Health Service, which is already woefully underfunded, will lose a major source of revenue.

“Today, Medicaid represents 67% of 3rd party revenue at the IHS, and 13% of overall IHS spending,” the National Indian Health Board and the National Congress of American Indians wrote in a joint letter to Rep. Paul Ryan (R-Wisconsin), the Speaker of the House.

“However, this amount is just 0.15% of total national Medicaid spending. These proposed changes to the Medicaid program will mean less services for AI/ANs and increased pressure on the severely underfunded IHS,” the March 23 letter to Ryan -- whose children are Chickasaw Nation descendants through his wife, according to a close relative -- stated.

As attention turns to the Senate, tribal advocates are already lobbying for improvements to the new version of the bill, which was made public just days before its passage. Some of them met with the leaders of the Senate Committee on Indian Affairs on Thursday as part of the effort.

“To raise the quality of life throughout Native communities, we must ensure that tribal members and families have access to quality and reliable health care,” Sen. John Hoeven (R-North Dakota), the new chairman of the committee, said in a press release after meeting with NIHB's board of directors. “This is often not the case for the many individuals whose sole option for a health care provider is the Indian Health Service.”

“Tribes deserve better – that’s why we’re working to reform the broken health care system for Natives,” Hoeven added, referring to forthcoming legislation to address longstanding management, financial and other issues at the IHS.

Sen. Tom Udall (D-New Mexico), the new vice chairman of the committee, also met with the NIHB board. But unlike Hoeven, who did not address the House vote on the health care bill, he was extremely critical of the legislation.

“President Trump and Washington Republicans are trying to force through a vote without a single public hearing and before Americans can learn exactly how much this disastrous, politically motivated gamble will cost,” Udall said in a press release.

The Senate, which is controlled by Republicans, is expected to develop its own health care package this summer. Although some in the chamber are opposed to Medicaid changes, one person thinks the repeal and repeal campaign will eventually succeed.

“We’re going to get this passed through the Senate. I feel so confident,” Trump said on Thursday.

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