President Trump is standing his ground on an issue which few presidents before him have had the courage to tackle: treaty rights and how they impact tribes across the United States. Specifically, tribe leaders are demanding exemptions from Medicaid working regulations on the basis that they are a separate government, and thus, don’t fall under the same rules used for everyday citizens.
• Trump believes tribes and their members should be reclassified as a race. This would place them on equal footing with every other non-tribal American with regard to Medicaid and many other social programs.
• Tribal leaders are accusing Trump of attempting to undo centuries-old protections originally put into place to prevent genocide. However, others argue that many of these old laws no longer apply because the world we live in is so much different.
• Thus far, the HHS is siding with Trump, stating they believe, “…that such an exemption would raise constitutional and federal civil rights law concerns.” They have also refused the same or similar requests multiple times when approached by tribal leaders in the past.
• Tribes believe they are exempt from racial preference claims because they aren’t qualified as a race in the first place. This is partially correct; “Native American” is an umbrella term used to encompass many different tribes and at least two distinct genetic lines, one in Alaska and one south of the Canadian border. However, the U.S. Government does recognize “Native American” as a race and has for some time.
• Statistics show that Native Americans experience more poverty than most of the rest of the United States. Most of what is traditionally classified as “Indian Country” has an unemployment rate of around 12 percent – three times the national average.
• If the exemption isn’t approved, it will directly impact Native American tribes from close to the Mexican border all the way to northern Alaska. Poor access to employment plagues many American reservations, and low funding also plays a role in the issue, too.
• Tribal leader W. Ron Allen explained the problem by pointing out the need for direct support. “Without supplemental Medicaid resources, the Indian health system will not survive.” Former Indian Health Services Mary Smith agrees; she says that, “Work requirements will be devastating. There are not jobs to be had on the reservation.”
• Not everyone feels the move is as drastic as it sounds. Many leaders believe it will encourage Native Americans to reduce their unemployment rate and get back to work. Even the HHS reaffirmed their commitment to Native health, indicating that the administration has “…taken aggressive action and will continue to do so to improve the health and well-being for all American Indians and Alaska Natives.”
• Requiring all Americans to adhere to work requirements would effectively save the government millions of dollars per year. It wasn’t immediately clear how much the gaps in coverage would cost tribes and tribal leaders across the country, who would be required to pick up the bill.