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Tribes scramble to avoid $1 million in fines under Affordable Care Act

Diabetes patient Jay Littlewolf says he sought medical help for a diabetic ulcer at a Billings hospital after not receiving "adequate health care through the IHS in Lame Deer." He wants reimbursement from the IHS and sought Sen. Jon Tester's assistance.Photo/Larry Mayer, Gazette staff — Diabetes patient Jay Littlewolf says he sought medical help for a diabetic ulcer at a Billings hospital after not receiving “adequate health care through the IHS in Lame Deer.” He wants reimbursement from the IHS and sought Sen. Jon Tester’s assistance.
Photo/Larry Mayer, Gazette staff

BILLINGS – Montana’s Indian tribes, which until recently thought the Affordable Care Act would pass them by, could face fines exceeding $1 million for not offering insurance to employees.

Beginning in 2016, businesses with 50 or more full-time workers will have to offer at least a minimum amount of health insurance to employees. Those who don’t comply face tax penalties, and that includes tribal governments.

The requirement has been a surprise to tribes, said George Heavy Runner, Blackfeet Insurance Services health and wellness coordinator. As individuals, American Indians have the option of choosing not to follow Affordable Care Act rules. Many assumed tribal governments, which are sovereign, had that same option.

“We thought this was a ship kind of passing us by,” Heavy Runner said. “But it’s not just a ship passing through the night. We have been identified in this legislation, just not where we thought we would be.”

Tax penalties facing the Blackfeet Tribe for not complying could be as high as $1.1 million. Crow Tribal Chairman Darrin Old Coyote said the size of the fee depends on how many people a tribal government employs.

“If we don’t do the mandate, we’re going to be fined for the number of employees we have, and that number could be up to $1.5 million,” Old Coyote said. “We pay federal tax, and our employees pay federal tax and so we’re part of the large employer mandate.”

The tribes can avoid the fees by offering the insurance to their workers. Old Coyote said the Crow have hired a benefits manager to do just that.

***

The change caught tribes off-guard because American Indians by treaty receive health care via the Indian Health Service on reservations. IHS is much maligned by tribal members for not providing adequate health care and for not covering services by specialists outside the IHS program.

Because IHS is limited, tribal members who work for their government would benefit from having other health care, Old Coyote said. The challenge is having a health care plan to offer by next year.

Suing to get off the employer mandate has already been tried. In February, Wyoming’s Northern Arapaho Tribe failed to convince a federal judge to block the employer mandate. The Northern Arapaho argued that subjecting tribes to the employer mandate was an oversight that overlooked treaty rights related to Indian health care, while also stating that tax credits and benefits granted to Indians under the Affordable Care Act would be denied.

Earlier this month, U.S. Sen. Steve Daines, R-Mont., and U.S. Rep. Ryan Zinke, R-Mont., announced a bill to exempt tribes from the employer mandate. Daines called the mandate a job killer for tribal governments, who wouldn’t hire as many employees if they had to pay significant penalties.

Other sponsors of the bill, such as Republican Sen. John Thune, of South Dakota, said it was unfair to exempt individual tribal members and not exempt tribal governments as well.

However, exempting tribes from the employer mandate won’t help the nagging problems with Indian health care, said a representative for Sen. Jon Tester, D-Mont.

“This bill does nothing to solve the underlying problem, which is crisis-level health disparities among Native Americans,” said Marnee Banks. “If we are serious about increasing access to quality health care in Indian Country, we will expand Medicaid and adequately fund the Indian Health Service.”

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IHS spending on Indian patients was $2,741 per person in 2013, according to the National Congress of American Indians, which asserts that IHS is severely underfunded. Medicaid spending, by comparison was $5,841.

The state of Montana is awaiting federal approval of the state’s plan to begin offering Medicaid to Montanans earning up to 138 percent of the federal poverty level.

Medicaid expansion would extend benefits to as many as 11,000 tribal members over the next four years, said Jon Ebelt of Montana’s Department of Public Health and Human Services. The program would benefit tribal health care in general, Ebelt said.

“Medicaid expansion revenue will be critical for building health infrastructure, expanding the workforce, and keeping health care providers in tribal communities,” Ebelt said. “Medicaid revenues will bring new funds to the programs and further investment in the Indian health system infrastructure and workforce. This is an opportunity to provide more health care services, create more jobs and employ more Native Americans in tribal communities.”

Old Coyote said he’s concerned that state benefits representatives won’t be able to clearly explain the expanded Medicaid program to some Crow Indians who speak Crow as their primary language. He’s asked the state to provide a benefits representative who is fluent in Crow.

Ebelt said the state is able to provide translation assistance if necessary and in determining an outreach plan with members of the Indian Health Service at Crow Agency.

Alaska expands Medicaid, becomes next state to add ‘new money’ to Indian health system

OPINION: The Affordable Care Act continues to evolve and improve, but more important, as more states expand Medicaid, they add real dollars to the Indian health system.401(K)2013 / cc via flickr — OPINION: The Affordable Care Act continues to evolve and improve, but more important, as more states expand Medicaid, they add real dollars to the Indian health system.
401(K)2013 / cc via flickr

By Mark Trahant, Alaska Dispatch News

These days “new” money is hard to find. That’s the kind of money that’s added to a budget, money that allows programs to expand, try out new ideas, and look for ways to make life better. Most government budgets are doing the opposite: Shrinking. Calling on program managers and clients alike to do more with less.

That’s why the news from Alaska last week is so exciting: Alaska’s new governor announced the expansion of Medicaid and this will significantly boost money for the Alaska Native medical system. Indeed, the significance of this announcement to the Indian health system was clear when Gov. Bill Walker and Department of Health and Social Services Commissioner Valerie Davidson made the announcement at the Alaska Native Medical Center on July 16. The governor took this action using executive authority because the Alaska Legislature had failed to even vote on legislation to accept Medicaid.

The governor says Medicaid expansion would reduce state spending by $6.6 million in the first year, and save over $100 million in state general funds in the first six years. “Every day that we fail to act, Alaska loses out on $400,000,” the governor said. “With a nearly $3 billion budget deficit, it would be foolish for us to pass up that kind of boost to Alaska’s economy.”

“We know Gov. Walker has worked tirelessly to expand Medicaid since he came into office on December first,” Davidson said at the news conference. It was one of the campaign promises made by the independent governor. “He included it in the budget. He introduced a bill both in the House and in the Senate side. It was a subject of both special sessions. And, it’s the right thing do do for Alaska.”

The expansion of Medicaid is one of key components of the Affordable Care Act. It’s critical a tool for the Indian Health System because it opens up a revenue channel for clinics and hospitals to bill Medicaid, a third-party insurance, for services. That boosts budgets at the local level, in a political climate where Congress is unlikely to spend more money on Indian health. How big a number? More than a million American Indians and Alaska Natives are now insured by Medicaid. The Kaiser Family Foundation estimated in 2013 that Indian health facilities collected $943 million in third-party payments.

“By far the largest third-party payer is Medicaid, which accounts for $683 million or 70 percent of total third-party revenues, and 13 percent of total IHS program funding for FY2013,” Kaiser reported. Nearly 150,000 Alaska Natives and American Indians receive health services across the state from tribal and nonprofit health organizations funded by the Indian Health Service. By law IHS-funded clinics must seek third-party billing from patients, such as Medicaid, the Veterans Administration or private, employer-based health insurance.

Medicaid is an odd program for Indian country. Most of us understand the IHS to be the government’s fulfillment of its treaty obligations. However the agency has never been fully funded. Medicaid, however, is an unlimited check. If a person is eligible, then the money is there. Yet states, not tribes nor the federal government, determine the rules for Medicaid. And many Republican states have been determined to fight the Affordable Care Act, or “Obamacare,” at every turn, and that means refusing to accept Medicaid expansion (the U.S. Supreme Court ruled in 2012 that states could turn it down).

Alaska’s decision means the number of states rejecting Medicaid is continuing to shrink. Most recently, Montana agreed to expand Medicaid in April. The states with large American Indian and Alaska Native populations that have not expanded Medicaid include Oklahoma, South Dakota, Wisconsin, North Carolina, Maine, Wyoming, and Idaho. Utah is the next state considering an expansion.

The Affordable Care Act continues to evolve — and improve. But more important, steps that states are taking to expand Medicaid are adding real dollars to the Indian health system.

Mark Trahant is an independent journalist and a member of The Shoshone-Bannock Tribes. He served two terms as the Atwood Chair of Journalism at the University of Alaska Anchorage. For updated posts, download the free Trahant Reports smartphone and tablet app.

The views expressed here are the writer’s own and are not necessarily endorsed by Alaska Dispatch News, which welcomes a broad range of viewpoints. To submit a piece for consideration, emailcommentary(at)alaskadispatch.com.

Why Obesity and Heart Disease Hit Harder in Indian Country

Woman from the Confederated Tribes of Warm Springs prepares salmon. (Photo: Alyssa Macy)

And how to fix it.

By Francie Diep, Pacific Standard

The Navajo Nation covers 27,413 square miles. Serving that entire area, the territory has just 10 grocery stores. This means that, in order to get fresh, affordable produce, some Navajo Nation residents must drive at least 155 miles round-trip, according to one recent study.

This makes the Navajo Nation, like many other American Indian reservations, a food desert—a region in the United States where residents can’t easily buy fresh, healthy, affordable food. (Because of their setting, these food deserts are unlike those that normally show up in the news, which tend to be in urban centers.) In recent years, American public health researchers and policy experts have done a lot to document the effects of food deserts on people’s health, and to suggest solutions. Yet, in all that talk, nothing quite seemed like it would work for the people Crystal Echohawk and Janie Simms Hipp serve. “The policy levers were off,” Hipp says. “They were not a good fit because of the uniqueness of Indian Country.”

Hipp is an agriculture lawyer who directs a research institute at the University of Arkansas School of Law. Echohawk runs her own consulting firm in Colorado that advises non-profits working on American Indian issues. Together, they advocate for American Indians to gain better access to healthy food, which would in turn reduce rates of obesity, diabetes, and other diet-related ills that run rampant in the Native American population as a whole. Over 80 percent of American Indian and Alaska Native adults are overweight or obese; about half of American Indian children are at an unhealthy weight; and it’s estimated 30 percent of American Indians and Alaska Natives have pre-diabetes. Compare those statistics to American adults in general, two-thirds of whom are overweight or obese, and 27 percent of whom are estimated to have pre-diabetes.

“Oftentimes, when conversations are had with policymakers or philanthropy or public health, people just turn away and say, ‘We don’t know where to start. The problems are too big for us to solve.’ But there’s no shortage of opportunity for real change.”

Conventional fixes probably won’t work. But Echohawk and Hipp have ideas for what will. Together with lawyer-activist Wilson Pipestem, they put together a report for the American Heart Association about how to address the unique burden of diet-related disease that the U.S.’s indigenous people carry. “I think, oftentimes, when conversations are had with policymakers or philanthropy or public health, people just turn away and say, ‘We don’t know where to start. The problems are too big for us to solve,'” Echohawk says. “But there’s no shortage of opportunity for real change.”

Pacific Standard recently talked over the phone with Echohawk and Hipp about what makes it hard to stay healthy while living on reservations and trust lands—what’s collectively called Indian Country—and how a local food movement and cultural programs can make it easier:

What are some examples of policy ideas for reducing obesity that weren’t good fits for Indian Country?

Janie Hipp: I’d served for six years or so with the Bush and Obama administrations at the U.S. Department of Agriculture. I was always struck when policy, at the national level, was really bearing down on food deserts. They talked about encouraging retail food outlets to carry more healthy food products or fresher produce. That’s great, but if you have no retail food outlet, then you’re actually talking about a whole different policy arena that you need to wrap your head around.

Crystal Echohawk: There’s just the assumption that people already had outlets, that they were in urban centers. There’s also the lack of understanding of tribes as sovereign nations and their ability to institute a level of policy change over their tribal citizens. Now, a lot of the policy change that is being advocated is at the state level. But when we really look at the biggest levers of change in Indian Country, we look at the level of tribal government and we also look at federal because of the government-to-government relationship that tribes have with the federal government.

I saw that the Navajo Nation this year instituted a tax on junk food. It also made fresh fruits and vegetables tax-free. I can’t imagine a state doing that. New York City tried to institute a sugary-drinks tax and it failed.

CE: There’s immense opportunity for real change in Indian Country. What Navajo Nation did, I think, is just one example. There are just so many more opportunities aside from a tax.

What’s one of your favorite ideas for improving healthy food access in Indian Country?

JH: The vast majority of the foods that are raised for human consumption on our reservations leave the borders of the reservation. If the levers are pulled in such a way that feeding people healthy, local food comes first, before you feed folks outside of those reservation boundaries—you can do both—then we are within reach of having a major shift in our health. And oh, by the way, [by selling locally grown food locally] we also can build strong rural and remote economies.

Why does all the food leave?

JH: What is lacking in all rural communities—it’s not just Indian Country, but the lack is more profound—is the infrastructure necessary to do the harvesting, grading, packing, storage, freezing, all of those things that allow you to store and move food around more locally. Re-building those infrastructure pieces, or building them outright, is an important piece that can’t be ignored.

What’s wrong with growing food on tribal land and having that shipped out, and then having something else shipped in, instead?

JH: Being able to retain as much healthy local food around our communities as possible is going to lead to fresher produce being available to us. On the meat side, that’s been a phenomenon for years, where livestock is raised on our reservations, but they leave the reservation boundaries and, in many cases, never return. Or they make a circuitous route across the U.S. before they get back. Think about the cost associated with that. All you have to do is go into a grocery store close by any of our remote reservations and you will noticeably see the cost of food is much higher, and that’s not even talking about Alaska.

Why do you think American Indians have higher rates of obesity and diabetes than Americans in general?

CE: Poverty is a root cause. It’s a lot cheaper to go to McDonald’s and order stuff off the Dollar Menu than it is to go in and buy fruits and vegetables in a store when you’re looking at many families that are surviving on one paycheck and feeding a dozen people.

Another important component is how we’re addressing historical trauma within Native American people. There’s been increasing research out there linking trauma to health disparities. When you look at the history regarding Native Americans, of forced removal, of genocide, the boarding schools, it’s layer upon layer of trauma that Native American people, over generations, have sustained

Maine American Indians, fishing for millennia, regroup as latest effort for state pact fades

By Patrick Whittle, Associated Press

BANGOR, Maine (AP) — Marie Harnois stands on the banks of the Penobscot River at dusk, swirling a dip net under the water, fishing for eels — something her ancestors in the Passamaquoddy tribe have done for thousands of years.

Fishing has been a way of life for Maine’s American Indians since time immemorial — “Passamaquoddy” is derived from a word that means “the people who spear pollock” — and Harnois thinks it’s past time the state government’s regulators came to the table to share management of fisheries with the tribes.

“I think the tribe should be able to set their standards however they want,” she said, alongside sisters Fawn and Eva, as she emptied wriggling baby eels into a bucket. “They’re perfectly capable of managing resources.”

Like Harnois, members of Maine’s four federally recognized American Indian tribes are regrouping just as a tribal effort to forge a fishery management pact with state regulators is faltering. The tribes proposed an ambitious bill that called for regulators and tribes to craft “memorandums of agreement” about managing marine resources.

The bill, which stemmed from recent squabbles the tribes have had with regulators about quotas and gear used in the lucrative baby eel fishery, was soundly rejected by a key state legislative committee in May, and it appears unlikely to pass if it reaches the full Legislature.

But former Passamaquoddy tribe legislative Representative Matthew Dana, who sponsored the bill and withdrew from his seat in protest last week, said he is hopeful the tribe and state can still reach agreement without passing a law. The tribes feel as though the state is preventing them from beginning an era of cooperation with a government regulatory structure with which they have frequently been at loggerheads, he said.

“I thought this was going to go somewhere, and obviously it did not,” Dana said. “We’re trying to keep the lines of communication open and hopefully meet before the start of the season next year.”

There are about 8,000 Maine residents of Native American descent, about 2,500 of whom are Passamaquoddies. The other recognized tribes are the Penobscot Nation, Aroostook band of Micmacs and the Houlton band of Maliseet Indians. They are descendants of the Algonquian-speaking Wabanaki peoples who lived in Maine before the time of the earliest European settlements. The tribes have harvested everything from lobsters to porpoises from Maine’s waters over the centuries.

In that time, their methods have changed. Oral traditions say Penobscots would fish for eels by poisoning the water with berries and plants. Today the tribes fish mostly with modern gear. The importance of fishing to the tribes’ culture, however, has never wavered, Dana said.

“We know the importance of maintaining the balance of nature and the natural systems,” he said in a presentation to a legislative committee earlier this year. “We take only what we need.”

Tribal-state relations have a long and frequently difficult history in states around the country, particularly in managing resources, but there have been recent breakthroughs. In Washington, Gov. Jay Inslee this month signed a bill into law that creates a method for tribes to enter into pacts with the government to sell marijuana.

Maine Marine Resources Commissioner Patrick Keliher is “open and committed to dialogue with the tribes,” a spokesman said. Keliher opposed the tribes’ plan for shared management of fisheries, and he and his department have sparred with Passamaquoddies in recent years.

Keliher criticized Passamaquoddy leadership last month about the tribe’s use of fyke nets to fish for baby eels. The eels, also called elvers, are a moneymaking species that is highly prized in Asian markets, sometimes selling for $2,000 per pound, and are subject to strict quotas. Both tribal and nontribal members fish for them in the state’s rivers and streams. Keliher said the tribe’s gear could cause the state to exceed the quota, but Passamaquoddy leaders have said the tribe plans to continue using the nets.

The Penobscot Nation and Passamaquoddy Tribe have also said recent actions by Gov. Paul LePage, such as the withdrawal of an executive order that sought to promote cooperation between the state and the tribes, have damaged relations. The two tribes and the Aroostook Band of Micmacs said in a joint document on Wednesday that they are no longer recognizing the authority of state officials, lawmakers and courts to interfere with their “self-governing rights.”

And a year ago, the tribe resisted the state’s effort to enforce quotas on individual tribal elver fishermen. The Passamaquoddies believe natural resources belong to all tribal members and not individuals, but they eventually agreed to the quotas.

Back in Bangor, Fawn Pirruccello, one of Harnois’ sisters, was having better luck with her elver catch than she had expected. All three sisters, in fact, were doing well for the breezy, cool conditions of a May evening. While she said she’s not a big fan of the quotas, for now, state laws leave her little choice.

“Like anyone else, I don’t like them,” she said. “But there’s not much you can do.”

Feds, tribal police target heroin ring centered on 2 Minnesota reservations

By Elizabeth Mohr, Pioneer Press

Minnesota’s U.S. attorney on Thursday announced an indictment against 41 people and the “dismantlement” of a multistate heroin-trafficking ring that targeted American Indian reservations.

Investigators tracked the ring, led by Omar Sharif Beasley, 37, for the past year and confiscated 2 kilograms of heroin, 1 kilogram of cocaine, hundreds of pills and numerous weapons, U.S. Attorney Andrew Luger said. The operation netted the traffickers millions of dollars, he said.

“With Beasley out of business, there will be less heroin sold in Minnesota,” Luger said.

The group’s business model allegedly centered on distributing drugs on the Red Lake and White Earth reservations in Minnesota, as well as at least one reservation in North Dakota, though the dealers themselves were not tribal members.

Tribal police who spoke at Thursday’s news conference with Luger said drug use on the reservations has become epidemic and is tearing families apart.

William Brunelle, director of public safety for the Red Lake Tribal Police Department, said, “The pain and suffering surrounding addiction, overdoses … is devastating.”

In 2007, American Indians accounted for less than 3 percent of those seeking treatment for opiate addiction in Minnesota, Brunelle said. By 2014, that figure had risen to more than 13 percent, he said. “We are nearing a crisis.”

Randy Goodwin, director of public safety for the White Earth Tribal Police Department, called the effect on the tribal community “horrific.”

“Many lives, families and communities have been destroyed by this poison,” Goodwin said.

“Our elders have been victims of threats, abuse and theft. Home invasions and crimes of violence have increased. And sadly, even some of our newborn babies have been exposed as a result of mothers using during pregnancy.”

Goodwin said that, while law enforcement focuses on drug trafficking, efforts must be made to ensure a “safe environment for future generations.” Plans and programs are underway to address addiction and to keep families together, he said. “Now the hard work of healing and wellness begins.”

With 35 of the 41 defendants in custody, Dan Moren, special agent in charge of the federal Drug Enforcement Agency’s office in the Twin Cities, called the bust a “dismantlement of a significant prescription drug- and heroin-trafficking organization.”

Luger said the indictment covers nearly everyone involved in the organization.

He offered a warning “to those who would try to step into the shoes of the Beasley organization to sell heroin in Indian country,” saying his office and law enforcement would investigate and arrest people who bring heroin into the state.

“(We) will do everything we can to protect the people of Minnesota in every corner of Minnesota, from the trafficking of heroin,” Luger said.

A little more than a year ago Luger announced his office’s involvement in “Project Exile,” which launched a focused effort to combat heroin trafficking in Minnesota and netted more than 100 arrests, he said. That investigation produced information about the organization and structure of trafficking rings, as well as names of key players, Luger said. The focused effort led investigators to the Beasley operation, allegedly importing drugs from Michigan, Wisconsin and Illinois.

Beasley’s 40 co-defendants range in age from 23 to 67 and hail from the Twin Cities, Detroit, Chicago, Red Lake, White Earth, Duluth, Milwaukee and elsewhere in Minnesota, Michigan, Illinois and Wisconsin.

Heroin and opiate use has been a growing problem in Minnesota in recent years.

According to the U.S. Department of Health and Human Services, there were 568 emergency room visits for heroin poisoning in Minnesota in 2012, up from 111 in 2001.

According to an April report tracking drug trends in the Twin Cities, “heroin accounted for a record-high 14.6 percent of total treatment admissions in 2014, compared with 14.0 percent in 2013. This compares with 7.8 percent in 2010, and 3.3 percent in 2000.”

Seizures of heroin and prescription drugs in Minnesota declined in 2014, but the DEA and Hennepin County reported increased numbers, the Drug Abuse Dialogues report said.

In Hennepin County, there were 102 opiate-related deaths in 2014, compared with 132 in 2013 and 84 in 2012.

Data for heroin-related deaths for earlier years have been unreliable due to inconsistent or nonspecific categorization, though efforts are underway to better track them.

Moren pointed out that the heroin coming to Minnesota is cheap and relatively pure and that Beasley and his crew peddled both heroin and prescription drugs.

With the bust of a major supplier, Moren said, the focus should now be on treatment and rehab. “When the demand stops, so does the supply,” he said.

Dan Bauman contributed to this report. Elizabeth Mohr can be reached at 651-228-5162. Follow her at twitter.com/LizMohr.

Local tribes continue fight for federal recognition

By Jacob Batte, The Courier

HOUMA, La. (AP) – For local Indian tribes seeking federal recognition, congressional pushback is disappointing, but nothing new.

U.S. Rep. Rob Bishop, R-Utah, is demanding the Obama administration hold off on new rules that could make it easier for Indian groups to win federal recognition as tribes.

American Indians have been pushing for years to revise the process, but proposed regulations nearing the finish line have deeply divided existing tribes and Congress.

Bishop says he’s prepared to use every tool at his disposal to block enactment of the regulations. He criticized the Interior Department for forwarding the regulations to the Office of Management and Budget for final approval last week. He said the administration has ignored lawmakers’ requests to hold off on the rules until Congress has a chance to review them.

Albert Naquin, chief of the Isle de Jean Charles band of the Biloxi-Chitimacha-Choctaw, which includes about 600 members, said he’s saddened by the lengths some politicians have gone to hold tribes back.

Asked to comment on the efforts of people like Bishop, whom Naquin likened to anti-Indian President Andrew Jackson, he said he didn’t know how to answer the question, “but to get mad and express my real opinion.”

Federal recognition has been granted to 566 American tribes, and it is sought by others because of the health and education benefits it brings to tribal members, along with opportunities for commercial development.

Under the current recognition process, which dates back to 1978, the Interior Department has recognized 17 tribes and denied 34 requests, including the United Houma Nation in 1996 because, according to the government’s judgment, the tribe failed to prove it had an unbroken connection to the historic Houma tribe.

The Houma Nation, which boasts some 17,000 members, is recognized by the state but has tried since the 1970s to win federal recognition, which tribal leaders say could open the door to grants to address poverty and improve education.

The Lafourche and Terrebonne parish councils have expressed support for both tribes as well as the Pointe-au-Chien tribe.

The tribe isn’t looking for “a check in everyone’s hands” but rather the chance for proper education, health care and a sense of solace knowing where they live won’t vanish into the sea, said Houma Nation Principal Chief Thomas Dardar.

Dardar said the tribe is looking for around 300 acres of land, but 10 acres at the start of the process. Federal recognition would aid in that goal, he said.

The fight for recognition is expensive to the tribes, Naquin said. His tribe has spent money it doesn’t have to research put together the proposal.

A proposed rule issued 11 months ago changes some of the thresholds groups would need to meet to be federally recognized as a tribe. For example, the proposed regulation reduced how far back in time a tribe must demonstrate it has been a distinct political entity with authority over its members.

The National Congress of American Indians, whose members include leaders from dozens of tribes, is supporting the administration’s efforts.

Republicans and Democrats in Congress have expressed concern about the cost to the federal government and how approval of new tribes could alter the casino landscape in their home states.

“They think it’s about casinos, which have benefited a lot of tribes in a lot of ways. Not every tribe has casinos,” Dardar said. “That’s not even on our radar. … We’re worried about land loss and becoming more resilient.”

Existing tribes have also raised the casino issue and say that adding tribes would stretch already scarce federal resources allocated for health care, education and housing for Native Americans.

Dardar does share Bishop’s concern over easing the process of obtaining federal recognition. While there’s too much red tape now, he said, it shouldn’t be so easy that “anyone can come along and say we’re a tribe.”

Local tribes are optimistic their fight for federal recognition will soon prove fruitful.

Naquin said his tribe has employed someone to write up its proposal for federal recognition, and he believes it meets all the criteria. Now, he said, it’s a matter of putting it all together in the formal application.

“We did our research and we’ve got it done,” Naquin said. “We’re doing everything we can so they can’t come back and deny us.”

Telehealth Project Aims To Improve Health Care Access for Inland Empire Tribes

By Lauren McSherry, California Healthline

A health care system serving nine American Indian tribes in the Inland Empire is using telehealth to reach patients in remote areas and address rising rates of diabetes, a particular problem among American Indians.

Riverside-San Bernardino County Indian Health serves nine tribes in the expansive Inland Empire region of Southern California. The region encompasses nearly 30,000 square miles, an area the size of Vermont and New Hampshire combined. Patients who live in rural parts of Riverside and San Bernardino counties must travel long distances for health care. Those who live near the Colorado River and in cities such as Needles and Blythe, which lie along the Arizona border, sometimes must travel several hours for specialty care.

“If you think about that vast expanse with an urban corner, it makes all the sense in the world to have all forms of telehealth,” said Mario Gutierrez, executive director of the Center for Connected Health Policy. “Telehealth has always been thought of as a rural tool.”

Indian Health is the largest tribally owned health care system in the state and one of the largest in the West, aside from the Navajo Nation and some tribally owned systems in the Northwest, said Bill Thomsen, chief operations officer. There are more than 50 health systems serving Indians in California, he said.

The health system exclusively serves Indians belonging to nine tribes in the Inland Empire and their eligible dependents. The health care system has seven health centers and 14,000 patients, Thomsen said.

In recent months, Indian Health has rolled out a telehealth project, which is initially focusing on endocrinology to combat high rates of diabetes among tribe members. In San Bernardino County, for example, 13% of American Indian adults suffer from diabetes, and nearly 80% are overweight or obese, according to Healthy San Bernardino County.

“Native Americans are the largest diabetic population in the world,” said Karen Davis, Riverside-San Bernardino County Indian Health’s clinical services director.

Overall, Indians face a scarcity of health care resources and unusually high rates of asthma, diabetes and heart disease. American Indians are 177% more likely to die from diabetes, according to Native American Aid.

Pulmonology, cardiology, gerontology and dermatology will be addressed in the project’s subsequent phases.

The project focuses on specialty care because 45% of the Indian health system’s patients don’t have health insurance, restricting their access to certain medical services, Davis said.

“The value that we have seen is increased access to care, which ultimately affects outcomes,” she said.

Gutierrez said that because of the region’s shortage of specialists, the endocrinology project can have a big impact because it is crucial to diagnose diabetes early and control it, he said.

“The earlier you intervene, the more likely you are to avoid debilitating effects — loss of limbs, eyesight, all those complications that can be prevented,” he said.

‘A Model for the Rest of the State’

Steven Viramontes, clinical applications and telemedicine coordinator for California through the federal Indian Health Service, said implementing telemedicine in rural areas is a “no brainer.” It addresses cultural considerations in providing medical care to American Indians and improves access for patients who would otherwise not be able to receive certain specialized medical and psychiatric services.

“They are taking this on in a stepwise fashion,” he said of the health system’s telehealth project. “And I think that can serve as a model for the rest of the state.”

Davis said cultural awareness is a particularly important component of the project. Patients prefer receiving care through the Indian Health system, rather than seeking specialized care outside of the system, she said. She added that building trust with patients is important.

“We want people who can interact with the patient in an appropriate and sensitive way,” she said.

Diabetes treatment must address cultural influences, such as diet and lifestyle, and providing treatment through a tribal health system ensures much better compliance and understanding among patients, Gutierrez said.

“It’s not just diagnostics,” he said. “It’s education.”

Coordination of Care

Davis said one of the reasons she has become such a proponent of telehealth has to do with improved efficiencies and savings through better coordinated care.

The health system is expanding its pilot project to include more clinics and specialists. The initial project linked three clinics with an endocrinologist who works for a separate Indian health system in Santa Barbara. Through the project, a primary care doctor or nurse and a patient can video conference with a specialist.

Primary care doctors can learn from the specialists by observing how they interact with certain health issues, and when they encounter a similar case, they can handle it more effectively, she said. The health system has found that costs drop because continuity of care is improved and duplication of services and tests is avoided, she said.

In addition to remote locations in the region, another challenge for the health system has been the Inland Empire’s shortage of primary care doctors and specialists, Davis said. Telehealth helps the health system circumvent that problem.

Gutierrez said this type of coordination of care is in step with the medical home model of care. Medical records can be kept in one place, and the primary care provider retains a full record of coordination with the specialist, he said.

Support Growing

While the implementation of telehealth has lagged for financial, regulatory and technological reasons, support for telehealth has been gaining momentum in recent months. Congressional backing for financial provisions for telehealth appears to be growing. In April, a number of senators expressed support for expanding telehealth. Also, an unprecedented number of telemedicine bills are awaiting action.

While California has not led the nation in telehealth implementation, it has remained in the middle of the pack. The American Telemedicine Association gave the state an overall “B” grade for its telehealth delivery and an “F” for its Medicaid coverage of telehealth rehabilitation and home health services, according to a report released May 4.

In California, one obstacle has been access to high-speed broadband in rural areas, Gutierrez said. Another has been cost. A lot of health centers don’t have the money to invest in technology and training, he said. However, he expects that health care reform will drive the adoption of telehealth as health systems move away from the fee-for-service model.

Viramontes sees telehealth as the future. He believes it can benefit Indian health systems across the state. Not only is telehealth a useful tool in rural areas, but it also brings people together to share skills and knowledge, he said.

“We see an opportunity here,” Viramontes said. “This is where we are headed.”

Maine Native Americans want state to come to the table on deal for elvers, other fish

By The Associated Press

PORTLAND, Maine — Maine’s American Indian tribes want state officials to come to the table for a potentially wide-reaching agreement about the way the tribes harvest commercial fish.

Passamaquoddy legislative Rep. Matthew Dana says members of Maine’s tribes have fished for thousands of years and deserve a bigger role in state decision making. His bill would allow for cooperative management of lucrative marine species such as lobsters, clams and baby eels.

The tribes’ request represents a broadening of an earlier drive by the tribes to get reach agreement with the state about fishing for baby eels. The Passamaquoddies and state regulators clashed last year about a state requirement that tribal elver fishermen be subject to individual quotas. The tribe eventually relented.

Connecticut’s Governor Tried To Crack Down On Predatory Lending And Got Accused Of Being Racist

dannel-malloy-ap-638x430 — CT Gov. Dannel Malloy (D)
CREDIT: AP

By Alan Pyke, Think Progress

As federal officials attempt to thread the needle between restricting predatory lending and ensuring that emergency loans remain available to America’s poorest, they’re trying to create a new and adaptable system of rules. But in one state, the traditional approach to payday lending is producing a strange public relations fight between lawmakers, a governor, Native American tribes, and a mysterious D.C.-based conservative PAC.

Months after Connecticut regulators imposed a large fine on an unlicensed internet lender, a series of billboards showed up near the state’s highways accusing Gov. Dannel Malloy (D) of attacking the economic future of American Indians. The campaign made a big splash in a state that has two Indian-run casinos, and reportedly even featured a billboard in New York City’s Times Square. But nobody’s sure who is really paying for the billboards, and both Connecticut’s own tribes and the Otoe-Missouria insist they are not involved.

Connecticut is one of 15 states that uses a low interest rate cap to effectively ban payday lending. But an online lender affiliated with the Oklahoma-based tribe found a way into the Nutmeg State anyway.

The state responded with a $1.5 million fine, $700,000 of it charged personally to Otoe-Missouria tribe chairman John Shotton. A judge rejected the Otoe-Missouria’s argument that its tribal sovereignty prevented Connecticut regulations from applying to its corporate partners. It is the second time in the past couple of years that a court has found that borrowing a tribal group’s name and legal authorities does not give a payday lending company immunity from regulation. Such partnerships remain rare – just 63 out of more than 560 federally recognized tribes have opened payday lending partnerships – but they return a tiny proportion of lending revenues to actual Native Americans in exchange for the theoretically legal indemnity the partnerships afford to the businesses that make the real money.

The fines were announced in January, but the billboards have put them in the news again. The signs are just one piece of an inflammatory campaign against Malloy backed by a D.C.-area conservative nonprofit with anonymous donors. Billboards, direct mail ads, and online communications paid for by the Institute for Liberty (IFL) accuse Malloy of destroying the economic future of native peoples. The group publicly accused Malloy of “bigotry against Native Americans” and operates a website replete with vaguely-captioned stock photos of people in stereotypically tribal garb. A journalist named Johnnie Jae who managed to contact the individuals in the stock photos told ThinkProgress that “the regalia is authentic, [but] the main issue is that these families had no idea these images were being used for this campaign and were appalled.”

IFL President Andrew Langer told ThinkProgress the group has been following payday lending regulations “for a good 18 months now” and said their focus is on the sovereignty of the tribes involved in cases like the Connecticut one. “We think this tribe has a right to engage in this business, and we think the state of Connecticut has no legal authority to go after them,” Langer said.

When the legal theory around tribally-affiliated lending evaporated in a Connecticut courtroom earlier this year, it set off a strange firestorm in the state that might end up further tightening Connecticut’s laws on the loans.

State Rep. Matt Lesser (D) is sponsoring a bill he hopes will sharpen the state regulations that made the $1.5 million fine possible. Current law limits the penalties for violating Connecticut’s interest rate laws to the amount by which the customer was overcharged. “We’re taking it a step further and saying that any loan that exceeds the cap, the Department of Banking can declare it unenforceable, null-and-void,” Lesser told ThinkProgress. “We’re hoping it creates that extra incentive for these payday loansharks to respect our laws and stay out of our state.”

Because IFL is a 501(c)4 nonprofit, it does not have to disclose who is financing its attacks on Malloy. “I will neither confirm nor deny that we’ve received money from tribal industries or payday lending companies,” he said, “but I will say that if they are supporting us I wish they’d support us more.”

“They deny that it’s the Koch brothers, for whatever that’s worth,” Lesser said. “You can sort of look at who benefits and draw your own conclusion.” The two national trade associations who have the most direct interest – the Native American Financial Services Association (NAFSA) and the Online Lending Assocation (OLA) – each emphatically denied involvement to ThinkProgress, with NAFSA’s spokesperson adding that the IFL campaign has “done more harm than good” to the Otoe-Missouria’s cause.

Enforcing rate caps like Connecticut’s can be important to protecting consumers, Pew Charitable Trusts small-dollar lending expert Alex Horowitz told ThinkProgress, but they’re not the only option. “Rate caps are important and states should continue to set them. If they don’t want payday lenders to operate in the state, they should set them at 36 percent or less,” he said. But a more flexible sliding rate cap system like the one in Colorado has kept credit available in emergencies and pushed average interest rates on the loans down to 115 percent – extremely expensive, but about a third of what unregulated states routinely see.

The fallout from Connecticut’s decision is coming just as federal regulators are in the process of writing the first-ever national code for payday lending, auto-title lending, and other forms of expensive small-dollar credit.

The fines are “kind of a traditional tactic,” Horowitz said, “but they’re doing it very aggressively.” Applying that classical enforcement approach gets a bit slippery when the lender is attached to a tribe. The Connecticut dispute, Horowitz said, “underscores why the CFPB’s rules are so important. While there’s been some uncertainty in the courts about how to handle state-tribe disputes, it’s clear that a federal rule from the Consumer Financial Protection Bureau trumps the other ones and would set a floor on rules for all of these.”

With its new regulations, the agency seeks to balance genuine consumer demand for emergency loans with the public interest in preventing the most predatory and abusive features of the traditional business model. While many states have taken Connecticut’s approach of preventing payday lenders from operating in any form, a handful of others have attempted the kind of hybrid system that CFPB is now aiming to build into federal law. The final rules are years away, but they will likely be modeled on the approach that states like Colorado take: limit the cost of these loans, prohibit the most egregious fine-print tricks lenders use, but make sure this lending remains economically viable so that desperate low-income people have somewhere to turn.

The idea that tightly-regulated payday loan shops can be a genuinely valuable service for the poor may need a lot more time to sink in in places like Connecticut that have decided a ban would be better.

“When you talk to folks [about] how they wound up paying these back,” Lesser said, “it’s often by doing the things they probably should’ve done in the first place. Turn to family and friends and existing resources to make up that difference.”

“Poverty stinks. It’s tough. But eventually people are going to have to reckon with the cycle of poverty and debt these guys are foisting on them.”

American Indians Among Eight Thousand Participate in Anti-Fracking March in Downtown Oakland

Largest Anti-Fracking Rally in United States history

By Nanette Bradley Deetz, Native News Online

OAKLAND, CALIFORNIA — On Saturday, February 7, eight thousand Californians marched in the largest anti-fracking demonstration in US history. The “March for Real Climate Leadership” was held in downtown Oakland, Gov. Jerry Brown’s home city, in order to focus on the need for Brown to end fracking.”We’re here, marching in Jerry Brown’s hometown, to let him know climate leaders don’t frack,” said Linda Caputo, fracking coordinator for 350.org, an international organization that fights climate change.

The marchers assembled in front of City Hall in downtown Oakland, then traveled nearly two miles to the Lake Merritt Amphitheater where a rally was held. Various marchers held signs proclaiming “Idle No More,” “Our Oceans Are Rising, so we Rise Up,” ” No Keystone Pipeline,” “Save the Delta,” “Save Mother Earth,” among many others.

DESPITE RAIN AND WIND, THE MARCH WOUND ITS WAY THROUGH DOWNTOWN OAKLAND WHILE NATIVE WOMEN SANG THE “WOMEN’S WARRIOR SONG.”

Nanette Bradley Detz & Pennie Opal Plant – Photo Credit: Steve Storm.

Pacific Islanders sang traditional songs, along with many marchers drumming, singing, and sending a peaceful yet powerful message to Gov. Jerry Brown.

The march was organized by a large coalition of environmental organizations composed of the Indigenous Block to end fracking that included SF Idle No More, led by Pennie Opal Plant, Marshall Islanders, various California tribes, including Ohlone leader, Corrina Gould, Los Angeles Chapter of AIM, AIM West of Northern California, and many Native Americans from the Bay Area and other parts of California. The Indigenous Block led the march. Other organizations included labor unions, local environment justice groups such as 350.org ,Food and Water Watch, national NGO’s, various health activists, community activists, students, and those committed to protecting water and air for generations to come.

“Fracking is hurting our communities. It is sucking our drought ridden state of precious water resources, contaminating our groundwater in a region where 25% of the nation’s food is grown, and contributing to the impending climate crisis. Oil companies have made Californians feel powerless and silenced, because our governor is only listening to their money,” UC Berkeley student Eva Malis said.

Photo Credit: Charles Lopez

Contingents of marchers traveled from San Diego, Los Angeles, Fresno, and the central coast of California. The rally at Lake Merritt amphitheater began with a traditional Pacific Island chant, then a prayer by Bay area Marshall Island community leader Abon-Burch. Fuifuilupe Niumeitolu then introduced a group of Marshall Island youth who sang traditional songs about water and love for their Moana. Dianne Thomas, a community organizer from Carson, California reported that in 2011 Occidental Oil Company wanted to re-open old oil wells and build 200 new wells over a period of ten years.

“As a community, we continued to organize and fight Occidental Oil, even though we only had the support of one council member in our favor. The draft EIR report never got out of the response phase, and eventually Occidental Oil pulled out of Carson. When we all work together, we can prevail,” said Thomas.

On Monday, February 8, organizers of the anti-fracking march and rally will present Gov. Jerry Brown with 200,000 signatures demanding an end to fracking throughout California.