Indian Country & health care reform

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.

But 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.