Finding consensus at Blair House on the Indian Health Care Improvement Act

By February 24, 2010No Comments

Op-ed by Mark Trahant

TrahantPresident Barack Obama is hosting a health care summit Thursday at the Blair House. It will be televised live. We can all watch and judge the proposals for ourselves. That transparency is an ideal opportunity for the president, Democrats and Republicans to put their best ideas forward and debate different approaches to solving the health care crisis.

“I am inviting members of both parties to take part in a bipartisan health care meeting, and I hope they come in a spirit of good faith. I don’t want to see this meeting turn into political theater, with each side simply reciting talking points and trying to score political points,” the president said in his weekly radio address. “Instead, I ask members of both parties to seek common ground in an effort to solve a problem that’s been with us for generations.

But after months of rancor about health care reform is there any common ground left? Absolutely. And I hope our elected leaders think so too.

First there is common ground on the fundamental nature of the U.S. system, employer-based health care. Neither Democrats nor Republicans dare attack what should be at the heart of the debate.

I’ll throw out my wishful thought for the day: We made a mistake with employer-based health care and should be looking for a national exit strategy.

But Democrats are attached to the current system in part because labor unions, a key constituent group, have fought hard battles to win health care benefits for workers. This notion would be fine except the nature of work is changing (if you are lucky enough to have a job). If you work for yourself (or even want to work for yourself) the prospect of buying insurance on the open market these days is daunting. For example I am relying on my former employer’s health care plan via COBRA. This plan is subsidized by a generous 66 percent subsidy from taxpayers (a back door approach to health care reform?) but when that ends in a few months I am not sure what I’ll do next.

On the other hand, the problem for Republicans is that once you say that employment-based health care is a mistake, the assumption is that the only alternative is a government-based single player plan. There are, of course, other options but how do you make the practical transition away from employer-based plans? Yet a shift of the health care responsibility away from jobs to individuals actually represents conservative ideas about individual responsibility.

But that’s enough trashing of the employer-based system. At least for now. There is a political consensus that employer-based health care stays. (Again, for now.) So the debate will be a back and forth about what goofy mechanisms are required to keep in place an illogical, impossible to design health care insurance system.

There is another issue of common ground that probably won’t get the attention it deserves on Thursday: Improving the Indian health system. This is clearly a government obligation and one where conservatives and liberals alike say the government has failed to live up to its promises. In an ideal world, that would mean full funding of the Indian Health Service.

But this week perhaps the best that can be done is an agreement to reauthorize the Indian Health Care Improvement Act. The president’s proposal includes this provision – as does both the Senate and the House bills. It should be an easy sell.

Will Republicans agree? A generation ago the original Indian Health Care Improvement Act had bipartisan support in Congress and was signed into law by President Gerald Ford.

Today one of the best cases for the conservative side of this debate comes from J.D. Hayworth. Hayworth is running against Arizona Sen. John McCain for the Republican nomination because, as Hayworth put it, McCain “campaigns like a conservative and … legislates like a liberal.” Hayworth’s credentials are solid in settings ranging from right-wing talk radio to any Tea Party assembly.

So what does Hayworth say about the Indian Health Care Improvement Act? As a member of the U.S. House of Representatives he testified in support for the reauthorization in 2004. “Unfortunately, today’s health care delivery to Native American communities remains disproportionately less than what the general population receives here in the United States,” Hayworth said.

Part of the problem, Hayworth said, is the that “year-by-year appropriation is not the optimal way to fund Indian health services. The tribes do not like it. Fiscal conservatives do not like it.”

Nothing has changed. Tribes still don’t like year-by-year approach. Fiscal conservatives ought not either. There is a lot of common ground here that could help produce a Blair House agreement.

Mark Trahant is an advisory board member of InvestigateWest and a Kaiser Media Fellow examining the Indian Health Service and its relevance to the national health care reform debate. He is a member of Idaho’s Shoshone-Bannock Tribes.

Rita Hibbard

Rita Hibbard


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