President Donald Trump and his administration have made entitlement reform one of their top priorities. However, a new move from the administration could be his most controversial yet.
According to Politico, the Trump administration plans to cut off health care to Native Americans who refuse to find employment, “a policy that tribal leaders say will threaten access to care and reverse centuries-old protections.”
Several states are implementing Medicaid work requirements, something the Trump administration has encouraged.
However, Native American tribes view themselves as being exempt from these work requirements, arguing that tribal lands represent independent nations.
“But 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,” Politico reported Sunday.
“(Health and Human Services) believes that such an exemption would raise constitutional and federal civil rights law concerns,” a review by Trump administration lawyers reads.
Health and Human Services has confirmed that the tribes have asked for an exemption several times and have been turned down each time.
HHS spokeswoman Caitlin Oakley said officials “have made it clear that HHS is open to considering other suggestions that tribes may have with respect to Medicaid community engagement demonstration projects,”
“The United States has a legal responsibility to provide health care to Native Americans,” said Mary Smith, former acting head of the Indian Health Service during the Obama years and a member of the Cherokee Nation.
“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?”
So basically, here’s the argument: During the early years of this country, horrible things were done to Native Americans by the U.S. government — who, in fairness, got almost as good as they gave. Nevertheless, our treatment of Native Americans is a sorry chapter in American history — perhaps our worst moment. This sorry chapter means, in 2018, that Native American Medicaid recipients cannot get a job and should not be compelled to look for one.
If you feel there are a few steps missing in that argument, you’re not alone. However, the persistently high unemployment in the Native American community has leaders worried, particularly because welfare benefits, “which many of the nearly 3 million Native Americans rely on,” could be next to be revamped.
“It’s very troublesome,” said Caitrin McCarron Shuy of the National Indian Health Board
“There’s high unemployment in Indian country, and it’s going to create a barrier to accessing necessary Medicaid services,” she said, adding that Native Americans suffer the highest drug overdose rates in the country. Unemployment, meanwhile, hovers around 12 percent.
This is truly tragic, but what to ought to really worry people is these numbers make it clear that the Medicaid program and welfare haven’t worked for Native Americans. And unemployment is far from the only issue Native Americans living on reservations face.
The 2015 National Survey on Drug Use and Health found that 9.2 percent of Native Americans over the age of 12 were heavy alcohol users, the highest of any group. Native American women report the highest incidence of rape and assault among any group; most troubling is the fact that the majority of these assaults are perpetrated by non-tribal members, which means that reservation law enforcement does not have jurisdiction over them. Median income on reservations is $29,097; the average number nationally is $41,994. Native Americans also have a high school dropout rate twice the national average.
In short: the reservation system, the entitlements that go with it, and government entitlements in general aren’t working. In fact, much like impoverished Americans, entitlements haven’t helped Native Americans. Instead they’ve encouraged a victim mentality, indolence, and hopelessness.
Something needs to change. Oakley pointed out that the work requirements can be filled by attending job training or higher education. Both of these things, one might think, might be more meliorative than the status quo. Really, anything would be. Yes, when the Americans and other European armies fought wars against the Native Americans, it ended up catastrophically for the Indians. Much of that happened centuries ago. The reservation system has been in place for quite some time now, and it’s a mess. It’s time to stop blaming evil American hegemony and for everyone to start taking responsibility for a broken system.
Something needs to be done, and throwing money at the problem isn’t going to make it go away. Work and training requirements for Medicaid may be a small step, but it’s a tentative start in the right direction.
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