Race-based Medicaid policy ignores tribal sovereignty

Race-based Medicaid policy ignores tribal sovereignty
(MN File Photo) The Trump administration’s lawyers believe that exempting Native Americans from Medicaid work rules would “raise constitutional and federal civil rights law concerns.”

Jason Salsman/Multimedia Producer

Administration sees tribes as race of people, not sovereign governments

WASHINGTON — Indian Country has seen challenges to tribal sovereignty before.

But in the case of the Trump administration’s latest assertion regarding Medicaid work rules and how they should apply to Native Americans, the thought of tribes as separate sovereign governments may be completely ignored altogether.

In a story published April 22 in ‘Politico,’ “the Trump administration contends the tribes are a race rather than separate governments, and exempting them from Medicaid work rules — which have been approved in three states and are being sought by at least 10 others — would be illegal preferential treatment.”

According to ‘Politico,’ the administration’s lawyers believe that exempting Native Americans from Medicaid work rules would “raise constitutional and federal civil rights law concerns.”

Health and Human Services administrator Seema Verma backed the assertion with a tweet on April 4 saying, ‘doctors know that helping individuals rise out of poverty can be the best medicine!’

Arkansas, Kentucky and Indiana all have been allowed to institute work-requirements for Medicaid eligibility and other states are following suit in seeking similar mandates. Requirements would call for participants to work anywhere from 20 to 80 hours a month to continue receiving their health insurance.

Jacqueline Pata, the executive director of the National Congress of American Indians, agrees with Trump’s lawyers that it raises Constitutional concerns, but not in their interpretation.

“The new policy on Medicaid work requirements does not honor the duty of the federal government to uphold the government-to-government relationship and recognize the political status enshrined in the Constitution, treaties, federal statutes and other federal laws,” Pata said in an article in ‘Indian Country Today.’ “Our political relationship is not based upon race.”

According to the ‘ICT’ article, Medicaid and its eligibility expansion due to the Affordable Care Act, have become crucial for Indian Health Service funding. The article states that since the expansion, around 237,000 American Indians and Alaskan Natives in 19 different states have become insured, with Medicaid making up 13 percent of the IHS budget.

According to a letter from the Tribal Technical Advisory Group for Medicare and Medicaid, American Indians and Alaska Natives, “are among the nation’s most vulnerable populations, and rely heavily on the IHS for health care. However, the IHS is currently funded at around 60 percent of need, and average per capita spending for IHS patients is only $3,688.”

Although analysis clearly shows that more restrictions will lead to less Native Americans with access to health care, most troubling for tribal leaders nation-wide may be the stance of the administration that tribal health programs are “race-based.”

Some see this as a clear indication that historical precedence concerning the U.S. and its relationship to tribal Nations may be changing.

“The United States has a legal responsibility to provide health care to Native Americans,” Mary Smith, who was acting head of IHS during the Obama administration and is a member of the Cherokee Nation, told ‘Politico.’ “It’s the largest prepaid health system in the world — they’ve paid through land and massacres — and now you’re going to take away health care and add a work requirement?”

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