Indian Country & health care reform

Filed under: American Indians,Featured |

Our system ties health care to our jobs

There is much talk about the recession reaching bottom. The economy at a turning point. Again. The proof, at least this time, was the drop in the national unemployment rate to 10 percent.

shapeimage_2But that data point doesn’t really reflect the jobs picture in this country. Here are two better ones: State unemployment funds are running out of money; and 9.24 million people are working part time (slightly down from a month ago) who would much rather go full time job. A year ago the figure was 7.3 million.

Both of these numbers have huge implications for the health care reform debate. Too many people are working part time, without benefits, because it’s the only job they can find.

Mike Sherlock, an investment advisor, publishes a fascinating blog called MISH’S Global Economic Trend Analysis. He reports: “15 states have collectively borrowed more than $15 billion and another 9 states are in the red over unemployment benefits.” One the examples Mish cites is North Carolina North Carolina where high unemployment has cost the state $1.4 billion in debt, growing as much as $20 million a day. The state is hoping the federal government at some point will forgive these loans because there’s no real plan to pay it back.

“Let’s do the math. The state budget is $19 billion. Potentially $4 billion will be borrowed to pay unemployment benefits. In other words the state is borrowing an amount equal to 21% of its total budget just to pay unemployment benefits. Wow,” Mish reports.

That’s only one state of the 24 now in the red. Add to that the state projections for Medicaid and Children’s Health Insurance and the picture is more complete. And bleak.

Consider those who are working part time. If the economy is improving, folks should start getting more hours on the job (hopefully enough hours to qualify for benefits). But that will happen before new jobs are created. We have a long way to go.

Another element in this crisis is health insurance. Many of those who lost their jobs in the first wave are starting to run out of a federal subsidy for their health insurance under COBRA. Unless Congress acts (quickly) to extend that subsidy, health care costs for unemployed folks will be prohibitive. A family of four could see their health insurance costs go from roughly $500 a month to $1,500 a month. An increase that’s nearly impossible to cover without a job. A really, really great job, at that.

The context for all of this is that we have tied our entire health care system to employment. Most people get their health care through work. If health care reform passes, this should improve through new subsidies and exchanges – in a couple of years. But the trade off is a requirement to buy health insurance.

Indian Country is a special case. American Indians and Alaskan Natives will be exempted from the mandate. But there are employment-related questions that remain.

Would it make sense for an American Indian or Alaskan Native entrepreneur to buy health insurance for her workers? There would be no requirement. The individual member would still be eligible for Indian Health Service. And, by the same measure, would any individual on the reservation buy into a health insurance exchange plan, even if it were subsidized? Tribal governments would probably buy plans for employees, but that would not close the gap.

I started with this project with the idea that the country has much to learn from Indian Country about health care reform. The relationship between health insurance and your job is a good example of that thinking. There is no employment-based system that can accommodate those outside of the regular work force, those who fish, herd, or bead. At the same time fixing Indian Country’s structural unemployment – with rates that are unthinkable in any other context – must be a priority. This is a health care issue, too.


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Author: Mark Trahant (20 Articles)

Mark Trahant

Mark Trahant is a writer, speaker and Twitter poet. He is a member of the Shoshone-Bannock Tribes and lives in Fort Hall, Idaho. Trahant’s recent book, “The Last Great Battle of the Indian Wars,” is the story of Sen. Henry Jackson and Forrest Gerard.

3 Responses to Indian Country & health care reform

  1. I was very intrigued when I first read the headline for this story. However, I was not impressed by this story at all. I find myself asking “what was the point to this article?” I wasn’t expecting a profound 10 page essay but something containing substance. I feel as if though this article was included because it briefly talks about Native Americans and Health Care Reform… but only at the end. Maybe I need to determine what “Race-Talk” is about before offering my criticism but with a title like that I’m expect real conversation about race and its implications in society and not filler material. The author has an impressive bio but this article was poorly excused. Was the focus of the article on Indian County & Health Care Reform or Jobs and Health Care? There is a connection but that was not explained. As a member of a Native American tribe I feel as is though the author could have provided the reader with more first or second-hand experience or knowledge of the potential implications of health care reform on Native Americans.

    And D. Truth
    December 8, 2009 at 4:50 pm

  2. Hey Truth. Thanks for commenting. I definitely understand your concern. One thing I’d say is that this blog is going to include a lot of different types of articles. Some are going to be more in depth than others; you will see reviews, creative writing, videos, etc. I guess what I want to say is that the ‘race-talk’ part of the blog is precisely in these comments. I hope, and encourage you to comment often and express your concerns so next time we write an article on Indian country and Health-care reform (perhaps even in a follow-up), we can attend to your matters. One thing I will say that perhaps we can both agree on is the lack of attention on American Indian issues in general. That may be one reason why it’s difficult to write articles with substance on such issues. Either way; I want to know more, too. And hopefully we can get everyone some better information soon.

    Philip Kim
    December 9, 2009 at 9:49 am

  3. I regret this post didn’t track for D. Truth. And I am delighted to those concerns and learn from them.
    It’s important to note that this piece is part of a year long series with more than 30 articles so far. (The series can be found on my web site, It’s hard to deliver the kind of background suggested in each and every post. I hope the series is comprehensive. My goal is two-fold, first to show that there’s much to learn about health care reform from the Indian Health care system (even though it’s terribly underfunded) and at the same time to explain to Indian country about general reform will impact our system.

    My main point, one that I’ve said before, is about the limits of a system that links health care to employment. It’s particularly difficult for those outside of the mainstream economy. I think of my friends who fish.


    Mark Trahant
    December 9, 2009 at 10:16 am

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