Sen. Lisa Murkowski, R-Alaska, voted for the repeal of the Affordable Care Act without presenting an alternative to fund the Indian health system.

Obama Will Veto Senate Bill, But Will Next President?

Mark Trahant

Republicans who serve in the House or the Senate should be asked a simple question: How would you fund the Indian health system? The Affordable Care Act, or Obamacare, is a mechanism that has added new dollars to many tribal, nonprofit and Indian Health Service clinics and hospitals. So without Obamacare, what’s the alternative?

Thursday night the Senate voted to repeal the Affordable Care Act using the budget reconciliation process. The House will have to agree to the amendments and then it will be sent to President Obama. He’s already promised a veto.

But this is a presidential year. A Republican president would support this repeal effort. So it’s important to find out just what is the alternative (and not just for the Indian health system) to the Affordable Care Act.

Turns out House Speaker Paul Ryan said it’s time for Republicans to offer an alternative. “When people ask me what’s wrong with the law, I usually say to them, how much time do you have? But if I had to point out one thing, it would be the mandates, the restrictions, all the red tape. How do I know they have failed? You notice we don’t talk about lowering premiums anymore. We’re supposed to be happy if they don’t go up by double digits,” Ryan said Thursday in a speech at the Library of Congress. “There are a lot of other ideas out there, but what all conservatives can agree on is this: We think government should encourage personal responsibility, not replace it. We think prices are going up because people have too few choices, not because they have too many. And we think this problem is so urgent that, next year, we are going to unveil a plan to replace every word of Obamacare.”

Ryan and the Republicans would repeal every word of the law. Even though parts of the law are working really well. Look at the numbers. According to the Kaiser Family Foundation, the Affordable Care Act has resulted in “significant coverage gains. The number of uninsured nonelderly Americans in 2014 was 32 million, a decrease of nearly 9 million since 2013. ”

So any repeal discussion ought to start with that: Would you take away insurance coverage from 9 million people?

Indian health funding is at risk

Now let’s zoom in on the Indian health system. Senators who are running for re-election in states with large Native American populations should be pressed to present an alternative to fund Indian health.

Alaska’s Lisa Murkowski voted for the repeal (even though she had expressed concerns about the provisions in the bill to strip funding from Planned Parenthood). Yet in her statements on the Senate floor, and in a recent op-ed, the senator explains why she is against the law without so much as a single line about its impact on healthcare for Alaska Natives.

Alaska does have a special problem with the Affordable Care Act because of high premiums. And that’s worth fixing. But Alaska also has much to gain from the law, especially the expansion of Medicaid and new funding streams for the Alaska Native health care system. So the logic must be: In order to fix one problem we should make things worse?

Here are Senators who voted to repeal the Affordable Care Act and are up for re-election in states with a significant number of Native Americans: Murkowski, Sen. John McCain, Arizona; Ron Johnson, Wisconsin; John Hoeven, North Dakota; James Lankford, Oklahoma; and, John Thune of South Dakota.

The vote Thursday night was absent any discussion of Indian health. It’s as if Republicans hope no one will notice that a million American Indians and Alaska Natives are funded via Medicaid. Or that the Affordable Care Act includes the Indian Health Care Improvement Act. (To be fair: Not everyone would lose Medicaid insurance under the Republican’s repeal but it would result in millions of dollars less for the Indian Health Service budget. Perhaps more important, third-party insurance including Medicaid is funding that remains with the local service unit, clinics and hospitals.)

In an ideal world, Republicans would offer this alternative to Obamacare. They could say the United States will directly fund treaty obligations as an entitlement without requiring insurance or other bureaucratic steps. That would be a real answer.

Mark Trahant is the Charles R. Johnson Endowed Professor of Journalism at the University of North Dakota. He is an independent journalist and a member of The Shoshone-Bannock Tribes. On Twitter @TrahantReports

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