Exempting Native Americans from the mandate

 

There is growing consensus about a key element of health care reform: a requirement that you must buy health insurance. The idea is that the insurance pools would be less expensive if every American were included – especially younger, healthier workers who for a variety of reasons decide not to buy insurance. The reform proposals would require people to sign up for Medicaid, buy subsidized insurance, or purchase a policy at work or on their own.

This would be difficult in Indian Country. Already Indian Country reflects the highest number of Americans who do not sign up for Medicare, the closest thing we have to universal coverage for the elderly (by my count almost a quarter of Native American elderly are not on the program). The story for Medicaid is similar. Moreover in recent studies one of the reasons for the low participation is the notion expressed by many who did not believe they should have to sign up for any program because health care is a treaty obligation of the United States.

Speaking at the National Indian Health Board Consumer Conference in Washington, D.C., Health and Human Service Secretary Kathleen Sebelius said the president supports an exemption from that mandate for individual American Indians and Alaskan Natives. “I’m going to make it very clear,” she said, “the administration strongly believes that the individual mandate and the subsequent penalties don’t apply to American Indians or Alaska Natives.”

There is consensus that the Senate Finance Committee’s bill when it surfaces will reflect this notion. The House bill does not address exemptions, but at the NIHB conference, Rep. Frank Pallone, D-NJ, said he would introduce amendments along those same lines.

The exemption is critical, I think, because of the already low participation by Native Americans in existing programs such as Medicaid. The enforcement of this mandate will be through the tax code. I don’t want to get ahead of the debate, but the definitions and regulations will be critical. Will the penalty exemption apply to those living within IHS service areas – the “on or near” reservations. Or will it be where ever an American Indian or Alaskan Native person lives, say Phoenix or Seattle?

The other mandate question is will tribes be required, as employers, to purchase insurance? The House bill does not address the issue, but does require states and local governments to buy insurance. The Senate might be more inclined to grant some sort of penalty exemption. And, again, the details are where the questions surface: Since the tax code is the enforcement mechanism, would tribes (or other governments) be required to file some sort of tax return to the IRS? Would tribal enterprises be treated differently than the governmental services?

Answers are hard to come by right now. Every item is subject to two pressure points: First, rounding up the votes to pass a bill. And, second, the “scoring,” or the estimated cost of the legislation, by the Congressional Budget Office.

Mark Trahant is the former editor of the editorial page for the Seattle Post-Intelligencer. He was recently named a Kaiser Media Fellow and will spend the next year examining the Indian Health Service and its relevance to the national health reform debate. He is a member of Idaho’s Shoshone-Bannock Tribes. Comment at www.marktrahant.com

 

 

 

High Country News Classifieds
  • WATER POLICY ANALYST WITH WRA (BOULDER)
    Position Summary: Western Resource Advocates seeks a passionate Water Policy Analyst with knowledge of western water issues to join our Healthy Rivers Team to strengthen...
  • GILA NATIONAL FOREST
    9+ acre inholding. Passive solar strawbale off the grid and next to the Continental Divide Trail in ponderosa pine/doug fir forest at 7400.
  • HIRING BEARS EARS EDUCATION CENTER DIRECTOR
    Conservation nonprofit Friends of Cedar Mesa in Bluff, Utah is hiring an Education Center Director to oversee the operation of the Bears Ears Education Center....
  • PROGRAM MANAGER, SUSTAINING FLOWS
    Friends of the Verde River, Cottonwood, AZ. Apply at https://verderiver.org/employment-opportunities/
  • PROGRAM ASSOCIATE - VERDE RIVER EXCHANGE
    Verde River Exchange - Friends of the Verde River, Cottonwood, AZ. Apply at https://verderiver.org/employment-opportunities/
  • CODE COMPLIANCE OFFICER
    Teton County Planning & Building is hiring! Our ideal candidate is a team-player, a problem-solver, pays attention to detail, and can clearly communicate technical material...
  • ARCHITECTURE DRAFTSPERSON/PROJECT MANAGER
    Studio Architects is seeking a full time Architectural drafts-person/project manager with1-3 years of experience to join our firm. At Studio Architects our mission is to...
  • ASSISTANT MANAGER/TRAINEE, COLORADO RANCH
    needed for 16,000+ acre conservation property in south central Colorado. Qualified candidate would have experience working on a ranch or wilderness property, general forestry/fire management...
  • FARM HAND &/OR NANNY IN ESCALANTE
    Nanny for 18-mnth-old. Yearly salary, vacation, health insurance. Spanish/other foreign-language native spkr prefrrd.
  • EXECUTIVE DIRECTOR
    Washington Association of Land Trusts seeks an ED to build on WALTs significant success & to lead the association to new levels of achievement. See...
  • BEAUTIFUL CUSTOM STRAWBALE HOME IN WESTERN COLORADO!
    Secluded, energy efficient Southwestern home on 40 wooded acres. Broker - Rand Porter - United Country Real Colorado Properties. 970-261-1248, $425K
  • FORMER RETREAT CENTER/CONSERVATION PROPERTY FOR SALE
    57 acres in Skull Valley, AZ, 17 miles from Prescott, year-round creek, swimming holes, secluded canyon, hiking/meditation trails, oaks, pines, garden, greenhouse. House, office building,...
  • ARIZONA PUBLIC LANDS ORGANIZER
    Title: Public Lands Organizer About the Arizona Wildlife Federation (AWF) The AWF is a non-profit organization dedicated to educating, inspiring, and assisting individuals and organizations...
  • HISTORIC RANCH HOME W/ 20 ACRES
    Historic 1893 Ranch Headquarters. 4 Bdrm, 3.5 Ba, 4000 ft2. Remodeled 2002. Includes 2 studio apts, stables, arena, workshop, 5 RV hookups. Chirachua & Peloncillo...
  • VICE PRESIDENT OF RETAIL OPERATIONS
    The Vice President of Retail Operations will provide overall leadership and accountability for purchasing, product development, merchandising planning, visual merchandising, retail operational excellence, oversight and...
  • ASSOCIATE DIRECTOR
    Grand Staircase Escalante Partners seeks an experienced fundraiser with excellent communication and organizational skills.
  • PROGRAM MANAGER
    position in Phoenix with the Babbitt Center for Land and Water Policy.
  • ROADS END CABIN NEAR YELLOWSTONE
    Vaulted ceilings, two fireplaces, two bedrooms, loft, jetted tub, wifi. Forest, mountain views. Wildlife. [email protected]
  • ACCOUNTING CLERK
    Our director is seeking to employ the services of an Accounting Clerk to assist with various accounting and administrative tasks. This is a great opportunity...
  • EXECUTIVE DIRECTOR, COMMUNITY RADIO PROJECT
    Community Radio Project, Cortez, CO (KSJD & the Sunflower Theatre). Visit ksjd.org and click on the Executive Director search link. CRP is an EOE.