Jon Walker reported this week that Governor Dennis Daugaard's ideological stinginess will squeeze many low-income South Dakotans out of the health insurance subsidies available under the Affordable Care Act.
Here's some small comfort for near-poverty workers laboring in the Daugaard-Medicaid gap: they at least won't be harassed by the IRS for not buying insurance. In June, the U.S. Department of Health and Human Services issued its final rule on exemptions from the individual insurance mandate. The PPACA thus has hardship exemptions for folks who really can't afford to buy health insurance. Hardship conditions include homelessness, eviction, utility shut-off, domestic violence, death in the family, fire or natural disaster, bankruptcy, huge uninsured medical bills, unexpected home care cost increases, and having a Republican governor who's playing politics with your family's physical and financial health.
The PPACA exempts several other groups from the insurance mandate, although Indians, devout theists, and others are still welcome to buy insurance on the exchanges:
- Individuals who cannot afford coverage;
- Individuals with household income below the filing threshold;
- Members of federally recognized Indian tribes;
- Individuals who experience a hardship;
- Individuals who experience a short coverage gap;
- Members of certain religious sects [though I'm telling you, praying for divine intervention is not as reliable as a good insurance policy];
- Members of a health care sharing ministry;
- Incarcerated individuals; and
- Individuals who are not lawfully present [a.k.a. illegal immigrants—fire away, Stace and friends!].
[Centers for Medicare and Medicaid Services, press release, 2013.06.26]
Contrary to popular Republican smokescreen point, members of Congress are not exempt. Actually, members of Congress and their staff are the only Americans required to buy their insurance on the PPACA exchanges. The only "exemption" is that their employer, Uncle Sam, can contribute toward their coverage on the exchange, just as the federal government will continue to contribute toward health premiums for all other federal employees.
* * *
As the Affordable Care Act enhances the health and economic liberty of millions of Americans while protecting the working poor from undue burden, it also sends more federal dollars to South Dakota. We are receiving $1.2 million in federal grants to help South Dakota's tens of thousands of uninsured folks (not to mention thousands more like my family who will find the exchange a better deal than their current coverage) understand and sign up for the insurance exchanges. Local groups like Falls Community Health Center in Sioux Falls and Inter-Lakes Community Action Partnership in Madison will use those dollars to hire staff, pay for more work hours, and buy advertising and services that will help their neighbors and ancillarially juice the local economy.
Rep. Kristi Noem should love that.
From what I understand, Native Americans do have access to health care if they get a referral from IHS, Indian Health Service.
Native Americans have essentially zero costs to them for medical services. They also get gas vouchers to pay for driving to appointments and hospitals.
The US would save a chunk of money by moving to a single provider with supplemental insurance from insurance companies.
“Where White Man Went Wrong”
Indian chief Two Eagles was asked by a white U.S. government official, “You have observed the white man for 90 years. You’ve seen his wars and his technological advances. You’ve seen his progress, and the damage he’s done.”
The chief nodded in agreement.
The Official continued, “Considering all these events, in your opinion, where did the white man go wrong?”
The Chief stared at the government official then replied, “When white man find land, Indians running it, no taxes, no debt, plenty buffalo, plenty beaver, clean water. Women did all the work, Medicine man free. Indian man spend all day hunting and fishing, all night having sex.”
Then the chief leaned back and smiled, “Only white man dumb enough to think he could improve system like that.”
Douglas and John may keep their traps shut and let us tribal members answer for ourselves. Cory, as you probably know, those in areas without IHS, non-reservation areas or places without urban Indian Health are SOL when it comes to health care. I am glad that we are exempt, for sovereignty reasons, but don't think we have such a good time. IHS Contract Care won't even pay for vasectomies or to save a tooth (wrap it or pull it, as the case may be) and often refuses other measures since the sequestration happened. Add to that an insane amount of mismanagement and scandal within local IHS systems, tribal health is basically emergency care. Glad we have it, keeps some folks ticking awhile longer, but not a place you want to have to ever go.
Actually, Douglas and I might agree on something.
Give all tribal members free insurance for a provider of their choosing. Dismantle IHS and turn the facilities into non-profits, managed by tribal members independent of tribal governments.
A tribal member is staying with me, so I asked him about the IHS before I posted my comment, and showed him what Tasiyagnunpa had to say. He confirmed my opinion she's rude, but went on to say he has had a heart condition covered, feels pretty good about the medical care, and does not agree with her assessment it's basically emergency care. He also thought her description of mismanagement was extreme, but was in basic agreement on the other things. Pulling teeth rather than trying to save them is not dental care in my opinion, but then again I'm not sure if I'm allowed to speak.
Everybody that has posted is right in their own way. I have hauled friends to IHS many times and it is never good. Five, six, seven, or eight hours later something might have happened, and then again it might not have happened yet.
As an entity IHS is broken, to many people, not enough money to do the job right, and people that work there that only care about one thing, "going home at the end of the day." Single payer PPACA would fix that. But then again it would fix most of the other problems with health care to.
Why do we keep banging our heads on the wall when single payer would help everyone except the insurance companies.
Tasiyagnunpa Livermont the concept of a sovereign nation for reservations was an illusion from the start, it never has been and it will never be.
A sovereign state is a nonphysical juridical entity of the international legal system that is represented by a centralized government that has supreme independent authority over a geographic area.[1] It has a permanent population, a government, and the capacity to enter into relations with other sovereign states.[2] It is also normally understood to be a state which is neither dependent on nor subject to any other power or state.[3] The existence or disappearance of a state is a question of fact.[4] While according to the declaratory theory of state recognition a sovereign state can exist without being recognized by other sovereign states, unrecognized states will often find it hard to exercise full treaty-making powers and engage in diplomatic relations with other sovereign states.
I cant see that it has helped up till now. Can you?
The Blindman
I love how ignorance give as understanding about another group of politically recognized people is not rude, but I am. Well, you're right. I was rude. Sometimes I don't rise above the idiocy of others and wrongly think I can fight fire with fire.
Thank you for that lesson in nation states, Blindman. I guess my polisci professors are forever in your debt, because I wasn't paying attention in class. What you forgot is truly sovereign nations also have their own military and can print money. I mention that, because otherwise you basically described the rights delineated to the Oceti Sakowin Oyate, government-to-government in the Ft. Laramie Treaty.
Also, how is America, in trillion dollar deficit owned by other countries faring by your description? Doesn't sound too independent to me.
Is tribal sovereignty an illusion though? Probably, but not for reasons that you think.
And what about the gross national product of these sovereign nations? Time for the US to again declare war on the independent nations and then declare the US won and terminate the reservations in the same day.
I support single payer for everybody, then we won't have to feel envy about free medical care for others. We can all literally feel better.
"What you forgot is truly sovereign nations also have their own military and can print money. I mention that, because otherwise you basically described the rights delineated to the Oceti Sakowin Oyate, government-to-government in the Ft. Laramie Treaty."
No I never forgot any of that. I understand completely what has happened and it wasn't or isn't right but it is what it is, an illusion of sovereignty perpetuated by a government that had no intention of letting the reservations be sovereign in the first place let alone now.
"Also, how is America, in trillion dollar deficit owned by other countries faring by your description? Doesn't sound too independent to me."
Again I don't like it very much but it is what it is. At least there is a way to fix that problem, quit spending money that we don't have on bad wars, ungrateful country's, and governments that neither want or need our assistance in fighting their uncivil wars. But will that help the Indian nations any? Nope cant be done, they done slipped over the edge and are free falling.
I wish it weren't so but the once proud red race is now slowly turning pink and eventually will be mostly white. I liked it better the other way but again it is what it is. I cant fix it and you cant fix it, we are just along for the ride.
The Blindman
I'm just a little bit curious. What reasons do you presume that I'm thinking about when I'm talking about tribal sovereignty being an illusion?
The Blindman
The reasons you stated.
Pink? Yeah, I'm pretty pink. And the Scots were pretty Viking. Didn't stop them from wanting independence. And still wanting it.
It's unfortunate Tasiyagnunpa that you seem to have a large chip on your shoulder and express embitterment rather than trying to change minds. That's odd for someone who considers themselves a writer.
I do not have a chip on my shoulder. Sometimes, however, I do get very sick of playing nice with people who think they can speak for others, instead of waiting for someone with first-hand knowledge of something to speak up.
This is also why many tribal people are not good Democrats (or any other political party). Everyone assumes they know our lives.
Come on guys. Did it even occur to any of you that Cory has tribal members reading his blog who could have spoke to the issues of IHS and how single-payer will or won't affect us.
No, you just had to get in there and say what you thought you knew.
That is what irritates me, and it caught me on a Friday on a long week, and my inner editor had apparently checked out on me.
I do apologize for being rude, because I'm not usually a rude person, but neither am I perfect. I really love how everyone has jumped all over me for being rude, when we're on one of the most 'say what you think' blogs in the state, and everyone seems allowed their opinion.
But no. I'm a woman. A tribal member. A writer. So therefore, I should have not hurt your feelings or spoke out of turn? On a subject that I'm the only one out of anyone (unless someone here is a closet tribal member and I don't know it) to know about from experience.
I want to leave with this though: We all know reservations were once large concentration camps, with passes to leave and the phrase 'off the reservation' forever in the American English lexicon. Yet, people have to sneer at the ideal of sovereignty many tribal people cling to. We are trying to make lemonade out of lemons, composting centuries of American shit.
So, go ahead, assume you know everything. Wear your ignorance on your sleeve, and then wonder why Indians don't enter state politics, why so many keep to themselves (despite our own infighting), why we stay or return to the rez, why some shun education, why some still create our own newspapers and websites, why we simply 'say no' to your crap.
We just can't compost it anymore.
Stop baiting her, John. Leave your hurt feelings at the door and be an adult on an adult blog.
Ask a question about Indian Health Care and the PPACA. Tasiyagnunpa can answer it.
I appreciate this thread.
I guess I didn't think you were particularly rude, but I don't think we should need to wait for a tribal member to comment on issues because you assume all white-eyes are ignorant of reservation conditions and people.
I see Native Americans working harder in this community than many Whites, but they are the exception. I also see young Native Americans pushing strollers and pregnant with no means of support other than welfare and often multiple fathers of their children. This seems to me to be a real problem not just for Whites paying for this, but also for Native Americans who care about the future of their race.
Any Native American can get healthcare by walking into an emergency room or walking in the front door with an Indian Health ID. If this is not true, I would like to hear why. They get appointments with and care from heart, childrens' heart, renal, orthopedic, and eyecare specialists. KELO-TV shows free dental care on the reservations or is that all phony video?
If you see incorrect information or misinformation or myths that are not descriptive of reality, why not post corrective information (and not just more assertions about treaties and sovereignty) rather than launching into a rant about White ignorance. But don't expect everybody to accept every thing you write any differently than their reaction to other writers.
Perhaps just for curiosity you can explain why $15,000 was not enough money to run 22 voting stations in an area with rampant unemployment. $700 for an afternoon of work for several people would not seem to be terrible when nothing else is available.
How many $million did the federal government spend on a hospital on the Pine Ridge or Rosebud reservation just a few years ago?
Let me address your assertions and questions the best I can, and if I can't, I will tell you why.
"Any Native American can get healthcare by walking into an emergency room or walking in the front door with an Indian Health ID. If this is not true, I would like to hear why. They get appointments with and care from heart, childrens' heart, renal, orthopedic, and eyecare specialists."
Technically, we can all get emergency care by law whether we can pay or not. If I walk into a hospital ER in say, Brookings, a tribal ID isn't going to do jack for me. IHS Contract Health hates doing things after the fact and is slow to respond before the fact. The sequestration has further impacted their funding, or so they have been telling people. Some urban health areas, Rapid City, for example, take IHS contract care for birth. As for dental, the Delta Dental people show up now and again for the small number of people who can get there. Cheyenne River Health IHS in Eagle Butte has a dentist's wing. I toured it when I covered Sebelius's visit (http://westrivereagle.com/?p=805). Personally, as a family, our children qualify for CHIPS, so we take them to a dentist in another town that is one of few I know of in the state that is happy to take Medicaid. CRH IHS didn't have dentists for quite awhile, and so we started that before the dental wing opened. Delta still visits. Same for us with eyecare, we either go without or go to somewhere where we either pay cash or use Medicaid for the kids.
I don't know what $15,000 you are talking about. I can speak to the problem of chronic job shortage--everyone forgets how to work and those who know usually leave or work for peanuts, since there's always someone who will work cheaper than you do.
I'm enrolled at Pine Ridge, I know we have a new set-up, but I haven't lived at home for a long time so I can't answer. However, I can say, getting IHS workers is difficult. We don't exactly live in pleasant, clean, progressive (less politically, I mean nice commons, Downtowns, etc) communities. Most workers that I've met myself, usually at the ER but at the clinic too, are contract health workers. They come in for a set amount of time and go back home again. I stopped going to the clinic, because I don't trust people like that. I just don't. I'd rather scratch together $50 for an office visit to the ex-IHS doctor on main street when I'm sick than go to IHS. There's times where I've had to visit the ER, so I'm thankful for that. FYI: The IHS ER will see anyone, so it is a boon for non-tribal people in our area. The closest hospital is over a 100 miles.
Thanks for the information. I could not walk into the Brookings Hospital and expect instant service either because our healthcare is primarily through Sanford. Insurance is a pain in the ass whether your are red or white. I recently spent 45 minutes on a cellphone listening to "please wait". Please have your pharmacist try again. Please wait. etc. Music was also Mediocre. The people were pleasant and it finally worked. I still don't know if it was a problem with Humana or Sanford.
Anyway, if I drive west and must go to the IHS Hospital, I will not get gas money for the trip. Native Americans get vouchers which pay for the gasoline.
I am aware of the payment problems that now and again crop up with IHS leaving hospitals wondering if they will ever get the money owed them.
(Pushing strollers and pregnant with no means of support... why are we so quick to use the exercise of the right to bear children as an accusation of wrongdoing?)
Taunia, if a white man separated his race and told a woman outside his own to shut up because white people understand the issue, that white people should speak first, and with a broad stroke dismissed others as ignorant, I wonder if you would leave the same comment for her, that her feelings are not relevant. Yes, I goated her a bit, but if a person believes in equality, basically treating people fairly and respectably, then it should matter. It should be the goal, shouldn't it?
My initial comment was only to imply that if people have access to heath care, as my friend said he did before I made that comment, then it makes sense they shouldn't have to buy health insurance. While he's here I've asked him many questions about his experience. He lives in Rapid City and feels the hospitals there have provided good care and he basically sees it positively. While in Madison he would need to go to Flandreau. This is not ideal, and not like standard health insurance, but he's glad he's got the benefit. I had the same thought as Wiken, that there are many people unhappy with their current policies. Lots of things they won't cover, pre-approvals are necessary sometimes, the cost has gone up. There have been many discussions about health care on this blog.
There are no easy answers although I'm glad Obamacare is on the way. The Republicans are trying to stall. After we start to receive the benefits they know the issue will be dead, but until then they have a chance to change the law if they get the Senate and we elect a Republican president. Let's hope not!
There is a difference between the right to bear children or not, and the expectation that somebody else should pay for your inability to exercise self-control and produce generation after generation of offspring lacking self-control and generation after generation of welfare freeloaders..
Wow, Douglas Wiken, just wow. I was not sure, thought it, but was not sure of your position. Now I am and feel sorry for you. Your spew on Native welfare is so Jim Crow or worse, it is amazing. What ever did the Native people ever do to you to corrupt your heart?
Douglas, not everyone gets gas vouchers. It depends on the circumstances. Is it nice they exist? Sure. But if we had a better public transit system in our rural state, it would be a non-issue. I've never received a voucher. I don't even know how bad off someone has to be to get one. Usually people have to get on tribal transit if they can't drive for contract health, I think. Again, thankful I've never had to try it.
Also, tribal people don't have to get the insurance. Seems like we're all forgetting we can if we want to. Which I'm thankful for.
"Come on guys. Did it even occur to any of you that Cory has tribal members reading his blog who could have spoke to the issues of IHS and how single-payer will or won't affect us.
No, you just had to get in there and say what you thought you knew."
Lets see. I have lived here on the Pine Ridge as of the last of July for Sixty years. I do admit that I don't know everything but my experiences here and my osmosis emersion in the native American culture should be good for something.
You on the other hand left home years ago and now you are the ripe old age of 31 preaching to me about what I know and don't know, or even if I should be allowed an opinion on Indian matters.
Some thirty years ago I had a conversation with a vary smart man while we were coon hunting here on Pass Creek.
We were setting on the tailgate of his pickup waiting for the dogs to open and he asked my view on something going on in the tribe. I don't even remember what it was about at the time and to tell the truth it isn't important to this story.
I told him that it didn't really matter what my opinion was because I didn't have a voice when it came to tribal things.
He looked right at me for a long moment and then he said. Bill you live here on the reservation don't you? You care about what is going to happen in the future don't you?
I set for a little bit and answered him. Yes to both questions but, I'm not Indian so what is the use.
He then told me the one thing that has kept me asking questions and giving my opinion all these years. Bill as long as you live here on this reservation you are a part of it, Indian or not, you are a part of what happens here. That gives you a voice.
That man was Elijah Whirlwind Horse, president of the Oglala Sioux Tribe and a coon and coyote hunting friend. Nuff Said.
The Blindman
I'll give plenty of points to the Blindman for his knowledge and experience, but not you Doug. I have read "Dakota Today" occasionally for several years and I appreciate much you have to say. You are outspoken and passionate. But when it comes to American Indians you are simply racist. I know that will tick you off. Nonetheless, you describe yourself as racist with your own words. You have some examples of poor behavior, irresponsibility, lack of direction, and other undesirable characteristics. You then generalize those negativities to the entire population. You don't make similar generalizations in regard to more positive behaviors. That is the definition of racism.
I wish you would stop making racist comments here or elsewhere. It is simply unfair to attack an entire group of people based on your observations of a very small number of them. Racism is just wrong.
BTW, I have some Santee heritage and have never lived near a rez. What I'm saying here is based simply on what is right and what is wrong. I'm not an expert of right/wrong, but racism is universally accepted as Wrong.
For many years I have thought the failure of K-12 education was that the distinction between reversible and irreversible decisons was not being put to students. Why else all the drug, alcohol, sex abuse, etc...in both White and Native schools and those with mixed populations.
The recent Science Today has a Report on a longitudinal study of a thousand or so New Zealanders from age zero to around 40 with surveys and data collection every several years depending on their ages at the time.
I appears to pretty conclusively demonstrate that lack of self-control is a significant factor in success or failure in a number of areas of life. And not just for one generation, but for multiple generations. Head Start programs in the US could claim improvement in outcomes for children in those programs, but could not demonstrate IQ increases. Now it appears that self-control can be at least partially taught.
I hope to have more information on this and how it may relate to both Native Americans and Whites in South Dakota. Obviously it is not the case with ALL Natives, or ALL Whites if I need to make that distinction here.
Once I get the information condensed and find if any links to original data exist, I will slap them into Dakota Today. Improvement in self-control (and deferred gratification I assume) can be a very significant factor in what should be education ...especially when the self-control is not coming from nor being displayed by parents who have the same problems.
I read much of what might be called a romantic vision of noble savages and see the reality locally. The professionals of ethnic superiority claiming to represent the benefits of Native American language and lifestyle are doing a lot in their own benefit, but are causing serious impairments in progress of reservations and Native Americans.
I surely don't know what the solutions to the problems are, but I do know that returning to the buffalo commons and the 1870 lifestyle are not the solution to anything--- or we would not be discussing 21st century medicine as it relates to Native Americans and reservations.
The social and educational costs from this are immense.
Thank you for sparing me with your nonsense Mr. Wiken. Please do me a favor and keep that drivel in your own cesspool of thought and not on this platform. I see enough hatred without sacrificing any more of my time on whatever disparaging information you have about New Zealand. You had to go clear around the world to come up with something that means nothing. Sad.
I suspect most of us have the tendency to evaluate quickly and prefer to affirm what we already believe is true. It's reassuring, avoids uncertainty and confusion, but is not necessary true.
True, John, and funny—that realization hit me in junior high when I was thinking about crushes and religion.