{"id":573246,"date":"2018-05-03T09:38:27","date_gmt":"2018-05-03T15:38:27","guid":{"rendered":"http:\/\/nmpolitics.net\/index\/?p=573246"},"modified":"2018-05-03T09:38:27","modified_gmt":"2018-05-03T15:38:27","slug":"trump-takes-a-hard-line-on-tribal-health-care","status":"publish","type":"post","link":"https:\/\/nmpolitics.net\/index\/2018\/05\/trump-takes-a-hard-line-on-tribal-health-care\/","title":{"rendered":"Trump takes a hard line on tribal health care"},"content":{"rendered":"<div id=\"attachment_430425\"  class=\"wp-caption module image alignnone\" style=\"max-width: 771px;\"><img loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-430425\" src=\"http:\/\/nmpolitics.net\/index\/wp-content\/uploads\/2017\/09\/Shiprock-771x486.jpg\" alt=\"Shiprock\" width=\"771\" height=\"486\" srcset=\"https:\/\/nmpolitics.net\/index\/wp-content\/uploads\/2017\/09\/Shiprock-771x486.jpg 771w, https:\/\/nmpolitics.net\/index\/wp-content\/uploads\/2017\/09\/Shiprock-336x212.jpg 336w, https:\/\/nmpolitics.net\/index\/wp-content\/uploads\/2017\/09\/Shiprock-768x484.jpg 768w, https:\/\/nmpolitics.net\/index\/wp-content\/uploads\/2017\/09\/Shiprock-1170x738.jpg 1170w, https:\/\/nmpolitics.net\/index\/wp-content\/uploads\/2017\/09\/Shiprock.jpg 1200w\" sizes=\"auto, (max-width: 771px) 100vw, 771px\" \/><p class=\"wp-media-credit\">U.S. Geological Survey<\/p><p class=\"wp-caption-text\">Shiprock, which is located on the Navajo Nation in San Juan County, N.M.<\/p><\/div>\n<p><strong>COMMENTARY:<\/strong> Last week, the Trump administration made the remarkable step of asserting that tribal citizens should be required to have a job before receiving tribal health care assistance. Several states are seeking to force the requirement on tribal health care systems that have always operated within their sovereign nations. The Trump administration contends that tribal members should be considered a race, not a political class, as courts have always viewed them, and should not be exempted from state regulations,\u00a0<a href=\"https:\/\/www.politico.com\/story\/2018\/04\/22\/trump-native-americans-historical-standing-492794\" target=\"_blank\" rel=\"noopener\">Politico reported<\/a>.<\/p>\n<p>The administration has repeatedly denied requests from tribes \u2014 sovereign nations that oversee their own health care systems \u2014 that they be exempt from the Medicaid work requirement, which would force potential recipients of government health coverage to work or look for work. (For similar reasons of sovereignty, Native Americans are exempt from paying penalties for not having health coverage.)<\/p>\n<p>Kentucky, Indiana and Arkansas have been given federal permission to implement work requirement rules for Medicaid. Ten other states have made similar requests. More than 600,000 Native Americans live in those 13 states.<\/p>\n<aside class=\"module align-left half type-aside\">\n<h3>About this article<\/h3>\n<p>This article originally appeared on\u00a0<a href=\"https:\/\/www.hcn.org\/articles\/indian-country-news-trump-takes-a-hard-line-on-tribal-health-care?utm_source=nmpolitics.net&amp;utm_medium=web\" target=\"_blank\" rel=\"noopener noreferrer\">High\u200b \u200bCountry\u200b \u200bNews<\/a>\u200b,\u200b \u200ba\u200b \u200bnonprofit\u200b \u200bnews\u200b \u200borganization\u200b \u200bthat\u200b \u200bcovers\u200b \u200bthe\u200b \u200bimportant\u200b \u200bissues\u200b \u200bthat define\u200b \u200bthe\u200b \u200bAmerican\u200b \u200bWest.\u200b \u200b\u200b<a href=\"http:\/\/www.hcn.org\/subscribe?src=header\" target=\"_blank\" rel=\"noopener noreferrer\">Subscribe<\/a>\u200b,\u200b \u200bget\u200b \u200bthe\u200b\u200b \u200b<a href=\"http:\/\/www.hcn.org\/enewsletter\/commons-email-signup\" target=\"_blank\" rel=\"noopener noreferrer\">enewsletter<\/a>\u200b,\u200b \u200band\u200b \u200bfollow\u200b \u200bHCN\u200b \u200bon\u200b\u200b \u200b<a href=\"https:\/\/www.facebook.com\/highcountrynews\" target=\"_blank\" rel=\"noopener noreferrer\">Facebook<\/a>\u200b\u200b \u200band\u00a0<a href=\"https:\/\/twitter.com\/highcountrynews\" target=\"_blank\" rel=\"noopener noreferrer\">Twitter<\/a>\u200b.<\/p>\n<\/aside>\n<p>Indigenous communities already face\u00a0<a href=\"https:\/\/indiancountrymedianetwork.com\/news\/business\/getting-jobbed-15-tribes-with-unemployment-rates-over-80-percent\/\" target=\"_blank\" rel=\"noopener\">higher than average rates of unemployment<\/a>\u00a0and poor health, as well as a severe lack of job opportunities, and adding a work requirement for medical treatment on tribal lands could potentially exacerbate those pressing issues. Nevertheless, Trump\u2019s Health and Human Services administrator, Seema Verma, suggested in an\u00a0<a href=\"https:\/\/twitter.com\/SeemaCMS\/status\/981536661174710279\" target=\"_blank\" rel=\"noopener\">April 4 tweet<\/a>\u00a0that making patients work can be one way doctors can help them: \u201cDoctors know that helping individuals rise out of poverty can be the best medicine!\u201d<\/p>\n<p>The Trump administration\u2019s racial approach to tribes is \u201ca remarkable departure from U.S. history, U.S. policy, and U.S. law,\u201d Taiawagi Helton, a professor at the Oklahoma College of Law, told me. According to the Supreme Court, tribal citizenship is not a racial classification, it is a political one. When it comes to tribal members, the U.S. government is dealing with the citizens of another nation.<\/p>\n<p>All three branches of the government have affirmed the sovereignty of tribes since the founding of the country. In 1886, the Supreme Court affirmed the right of Congress to decide how to deal with tribal nations, giving the federal government enormous power over the hundreds of nation states within its borders. At the same time, the U.S. government has long recognized that generations of conquest have left those nations dependent on the federal government, and the U.S. has made explicit legal promises\u00a0<a href=\"https:\/\/www.ihs.gov\/newsroom\/factsheets\/disparities\/\" target=\"_blank\" rel=\"noopener\">to provide assistance<\/a>.<\/p>\n<p>\u201cProviding care through the Indian Health Service has been a part of the responsibilities that the United States voluntarily undertook,\u201d Helton told me. \u201cSo it would be extraordinary to claim that this is a racial classification, when it isn&#8217;t, and (deny) the commitment that we undertook, sometimes explicitly in a treaty and sometimes based on the guardian and ward relationship between the U.S. government and tribal governments.\u201d<!--more--><\/p>\n<p>In an interview with Politico, Mary Smith, a member of the Cherokee Nation who was acting head of the Indian Health Service under the Obama administration, underlined the federal government\u2019s responsibility to uphold commitments made to the tribes it had once sought to destroy. Medicaid, she said, is \u201cthe largest prepaid health system in the world \u2014 they\u2019ve paid through land and massacres \u2014 and now you\u2019re going to take away health care and add a work requirement?\u201d<\/p>\n<p>It\u2019s complicated, but broadly speaking, tribes are individual nations that have entered into treaties with the United States, under which the U.S. government promised to provide assistance to them. \u201cTo reject both of those things is contrary to both law and the moral standing of the United States,\u201d Helton said.<\/p>\n<p>Even with Medicaid, citizens of sovereign tribal nations still face more\u00a0<a href=\"https:\/\/www.npr.org\/sections\/health-shots\/2017\/12\/12\/569910574\/native-americans-feel-invisible-in-u-s-health-care-system\" target=\"_blank\" rel=\"noopener\">challenges accessing health care<\/a>\u00a0than the average American. Reducing or eliminating any of those funds could leave thousands of Native Americans with\u00a0<a href=\"http:\/\/thehill.com\/opinion\/healthcare\/378658-proposed-budget-for-indian-health-services-wont-treat-native-american\" target=\"_blank\" rel=\"noopener\">even less<\/a>\u00a0health care options.<\/p>\n<p>\u201cOfficially Medicaid represents 13 percent of the Indian Health Service\u2019s $6.1 billion budget (just under $800 million),\u201d\u00a0<a href=\"https:\/\/indiancountrymedianetwork.com\/news\/native-news\/trump-administration-supports-changing-indian-health-programs-will-sabotage-treaty-rights\/\" target=\"_blank\" rel=\"noopener\">writes Mark Trahant<\/a>, editor-in-chief of\u00a0<em>Indian Country Today<\/em>. And many of those states depend heavily on federal funding to provide health care to underserved areas. Trahant points out that in Alaska, for example, \u201c40 percent of its $1.8 billion Medicaid budget is spent on Alaska Native patients.\u201d<\/p>\n<p>Creating stricter rules for access, such as adding work requirements, will mean \u201cfewer people will sign up for Medicaid, and the Indian Health Service \u2014 already significantly underfunded \u2014 will have to pick up the extra costs from existing appropriations,\u201d Trahant writes. \u201cThat will result in less money, and fewer healthcare services, across the board.\u201d<\/p>\n<p>The assertion that tribal nations are a racial distinction and not a political classification also highlights the\u00a0<a href=\"https:\/\/www.teenvogue.com\/story\/native-tribes-could-lose-federal-recognition-of-tribal-sovereignty-under-trump\" target=\"_blank\" rel=\"noopener\">Trump administration\u2019s troubling lack of understanding about tribal sovereignty<\/a>. It is unsurprising that the current administration would hold such a misguided view on Native identity. In 1993, Donald\u00a0<a href=\"https:\/\/www.washingtonpost.com\/video\/politics\/they-dont-look-like-indians-to-me-donald-trump-on-native-american-casinos-in-1993\/2016\/07\/01\/20736038-3fd4-11e6-9e16-4cf01a41decb_video.html?utm_term=.e52d78d5a928\" target=\"_blank\" rel=\"noopener\">Trump testified before a House subcommittee<\/a>\u00a0and noted that certain tribal casino operators \u201cDon\u2019t look like Indians to me,\u201d indicating he views tribal membership on outward appearances, such as skin color or dress.<\/p>\n<p>The president, in other words, seems to have no interest in understanding Indian Country. That is unfortunate for the millions of Native Americans who belong to arguably the country\u2019s most invisible minority. Given that tribal nations once flourished across this continent, only to be decimated by colonization, upholding the treaties to care for the survivors\u00a0and their\u00a0descendants through a functioning health care system is the very least the U.S. could do.<\/p>\n<p>Wado.<\/p>\n<p><em>Graham Lee Brewer is a contributing editor at<\/em>\u00a0<em>High Country News and a member of the Cherokee Nation.\u00a0Agree with his opinion? Disagree? We welcome your views. Learn about submitting your own commentary\u00a0<a href=\"http:\/\/www.nmpolitics.net\/index\/commentary-submissions\/\" target=\"_blank\" rel=\"noopener noreferrer\">here<\/a>.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Yes, tribal nations are sovereign, but the U.S. still has obligations for their wellbeing.<\/p>\n","protected":false},"author":1,"featured_media":430425,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1192,16],"tags":[3307,117,709,116],"class_list":["post-573246","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-commentary","category-guest-columns","tag-donald-trump","tag-health-care","tag-native-americans","tag-washington"],"_links":{"self":[{"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/posts\/573246","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/comments?post=573246"}],"version-history":[{"count":0,"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/posts\/573246\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/media\/430425"}],"wp:attachment":[{"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/media?parent=573246"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/categories?post=573246"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/tags?post=573246"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}