Trouble for the Tribe

By STEVE CAMERON

Staff Writer

PLUMMER — President Donald Trump refuses to give up on his dream to repeal and replace the Affordable Care Act, and he’s determined to dig out the votes to do it by the end of next week.

The U.S. Senate, which carries the fate of Trump’s plan, is scheduled to recess on July 28.

If Trump’s demands — some observers called them “threats” aimed at holdout Republican senators — are causing confusion and stress in Washington, D.C., the reaction for the Coeur d’Alene Tribe is closer to non-stop nervousness.

Tribe officials say a demise of the law commonly called Obamacare could cause massive problems with the cost of health care — and overall quality of life — on the Coeur d’Alene Reservation, a swath of North Idaho running roughly from Worley to St. Maries, and in nearby communities.

“There are several difficulties that could face the Tribe and its neighbors throughout the region,” said Tyrel Stevenson, legislative director for the Coeur d’Alene Tribe. “It’s a bit complicated to explain, but the options actually go from bad to worse if the Senate finds enough votes to repeal Obamacare.”

Stevenson said short-term gain would be offset by longer-term pain.

“I know this may not make much sense immediately, but if they do repeal Obamacare, then the Tribe actually would be better off if they go ahead and vote for a replacement,” he said. “No one in Washington is focusing on this because of the health care battle, but Obamacare carries a rider that contains the Indian Health Service Reauthorization Act. If the Senate repealed Obamacare but did not replace it, there might not be a legal mechanism to continue funding the IHS.

“Needless to say, that would be a terrible result for the Tribe.”

Among the institutions at risk is the Benewah Medical and Wellness Center, a 50,000-square-foot facility in Plummer that now sports a budget of $18 million and treats 35,000 patients per year.

The Benewah Center is one of only two Native American health facilities in the nation that is operated solely by the host tribe — and also takes non-Native patients.

In fact, about 25 percent of the center’s budget comes from patients in the general area — most of whom are on Medicaid, the federal fund set up to assist America’s poorer citizens with health care costs.

“If the Senate finds the votes to replace Obamacare, virtually every Republican plan involves serious cuts to Medicaid, and that would harm the non-native population here quite seriously,” Stevenson said.

“The human equation comes first, of course, and it would hurt. But even on the business side, it would also reduce income to the medical center — money that would be tough to replace. It’s not like there is a pool of rich residents paying a huge share of the working costs.”

Stevenson doesn’t even want to think about what would happen if the Senate repeals Obamacare but chooses a two-year delay to replace it.

“I haven’t looked at every word in the legislation,” he said, “but the IHS reauthorization is definitely connected to it.

“And the odd thing is that they were not voted on as a package. The IHS funds just happened to be attached — I mean, it could have been a transportation bill or anything else.

“But here we are, looking at a worst-case scenario.”

The Benewah Medical and Wellness Center gets approximately 68 percent of its operating capital from the IHS under a compact signed with the federal agency, thus allowing the Coeur d’Alene Tribe to operate its own facility.

For the Tribe, the good news currently flowing out of the Republicans’ ever-changing attempt to gut Obamacare would seem to be the repeal-only option could finally be off the table.

Republicans have only a 52 to 48 majority in the Senate, so even with Vice President Mike Pence adding a vote, Majority Leader Mitch McConnell, R-Ky, could afford to lose just two party members to hold off a unified Democratic opposition.

Republican Sens. Lisa Murkowski of Alaska, Susan Collins of Maine and Shelley Moore Capito of West Virginia have announced publicly they will not support a repeal-only bill — making that plan a non-starter unless two of the three change their minds or a Democrat crosses the line.

“I honestly don’t think they have the votes,” Stevenson said. “Just doing the math, I feel better. But Trump is determined to do this at any cost, and he’s threatening everyone.

“It’s hard to resist your own party. It really is. But all three of those senators come from states that depend very heavily on Medicaid, and would really take a beating if it gets cut significantly.

“The same is true of a few other senators. Can they vote against their own constituents just to stick by President Trump?”

Stevenson made it clear that leaving Obamacare in place would be the Coeur d’Alene Tribe’s first choice — by some distance — with a repeal-and-replacement (perhaps with a softer Medicaid amendment) the next option.

“The repeal-only is too scary to think about,” he said. “Of course the Tribe would survive and somehow manage the health needs of natives and others, but it would be a tough assignment.

“I think I’ll just count the votes again, just to feel better.”