Asking President Obama about Indian Health Care
by Mark Trahant
President Barack Obama set a high standard for tribal-federal relations last year. "Today's summit is not lip service," he said at the summit. "We're not going to go through the motions and pay tribute to one another, and then furl up the flags and go our separate ways. Today´s sessions are part of a lasting conversation that's crucial to our shared future."
That lasting conversation is continuing as promised. It´s remarkable enough for a president and cabinet officers to meet with tribal leaders once during an administration -- but this second round means that the standard is now an annual event
So what should we be saying about our shared future?
I´d use this as an opportunity to prepare for the coming financial storm -- serious and long-term budget cuts that are coming from Congress -- as a way to reconfigure federal services to Indian Country.
Take Medicaid and Children´s health programs. One of the best ideas coming out of the health care reform process is a feasibility study exploring the treatment of the Navajo Nation as a state. In tough budget times this is huge because state governments want to limit enrollment in Medicaid and Children´s Health Insurance to save money. But eligible American Indian and Alaska Natives do not cost the states money -- it´s a 100 percent federal match. By moving the administration to the Navajo Nation, it makes it much more likely that eligible patients will be enrolled in Medicaid or Children´s health adding critical revenue to the Indian health system.
The Navajo Nation feasibility project is only step one. This should be the beginning of a process that singles out other tribes, or regional associations, into administrative units that could manage Medicaid programs without a state roll. Or as I have put it before, treat Indian Country as a 51st state.
As the federal budget gets tighter and tighter it makes sense to look for ways to cut administrative costs. A small office directly funding tribal programs at the Centers for Medicaid and Medicare is a lot more efficient than distributing money through some 37 state programs when the end payment eventually goes to either the Indian Health Service or a tribal contractor anyway. (If pitched smartly, states might even like this idea.)
The president has done a great job of protecting budgets directed at Indian Country during his two years in office. But that is going to be impossible in a Republican-controlled House of Representatives. In this environment, political rewards will go to those members of Congress who are the most aggressive, most passionate, most zealous about a creating a smaller federal government.
That very notion is an opportunity. Tribal governments are smaller and more efficient than either the federal or state governments and operate with a workforce that is less expensive both now and in the future. Just last month the White House announced a two-year freeze on federal pay. Again the pressure to cut administrative costs is an opportunity for Indian Country because tribes and other Native organizations can provide direct services at a lower cost.
Another way to think about that is by comparing pension obligations from state and federal governments to those of tribal governments. There is not good comprehensive data, but few tribes have benefits that are anywhere near as generous as those in state or federal programs.
President Obama will listen to many ideas at the Tribal Nations Summit. He´ll probably even get calls to protect federal spending as it currently stands. That would be a wasted opportunity because future budgets will be smaller no matter what. My hope is instead a focus on the practical. What can be done in the current political climate to the serve American Indian and Alaska Native people? What´s the best way to effectively manage the resources required? What´s a fair share when there´s fewer dollars coming from the treasury?
The answers ought to come from a lasting conversation about our shared future.
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