Election Initiative

Will the Affordable Care Act work? It's too early to know that answer. But this is not a new question in history. More than sixty years ago the Bureau of Indian Affairs was awful in its operation of health care programs. One doctor wrote: All we really need are good doctors, facilities and pharmaceuticals. I am weary." Congress finally got the message and in 1955 created the Indian Health Service. But that shift -- as dramatic as the one today -- worked and it significantly improved the quality of life for American Indians and Alaska Natives.

Medicaid is a particularly complex government insurance program for the poor. But for American Indians and Alaska Natives, Medicaid is also an odd partnership between states and the federal government. The U.S. pays the bills, but each of the 50 states decide the rules and what's authorized as a health care cost. And there's another problem: The Affordable Care Act expands Medicaid eligibility, but only about half the states are doing that.

There is not a lot of competition in health care, especially for American Indians and Alaska Natives who live on a reservation or in a native village. The one choice for health care is often the federal Indian Health Service or perhaps a locally-managed tribal or nonprofit clinic. But the Affordable Care Act changes that. Once you have an insurance card from a Marketplace Exchange or Medicaid ... then you have a choice.

The Affordable Care Act includes incentives for people to buy health insurance coverage at a reduced rate or even free. So why would American Indians and Alaska Natives purchase insurance? Because there are a lot of benefits to doing so, including money for medical-related travel, or improved medicines. But first Native Americans need to sign up. And the Government Accountability Office said that will only happen if there is a major campaign to education people about their expanded coverage options.

The reauthorization of the Indian Health Care Improvement Act had been stuck in Congress for nearly twenty years. So when health care reform moved front and center it became an opportunity to get that done -- and to add tribes to the larger discussion. The result, says National Congress of American Indians Executive Director Jaqueline Peta, is the Affordable Care Act, a law that's "very good" for Indian Country.

Written by Mark Trahant.

Denise Juneau, a member of the Mandan and Hidatsa Tribes of North Dakota, is the first American Indian woman to win a statewide election. After four years in office, she is now running for re-election as Montana's Superintendent of Public Instruction.

Written by Mark Trahant.

Interviews conducted and edited by Mark Trahant.

Native Americans make up less than one percent of the U.S. electorate. A tiny demographic slice. But even that small number has the potential to make a difference in a Western state like Montana. Native Americans make up about 8 percent of Montana, roughly 6.5 percent of all voters. A number that has been increasing since 2004. The Native American vote has become an important part of the electorate, helping to elect a governor, and six years ago, Senator Jon Tester. He won that election by only a fraction and he credits the Native American vote for his win.

It's not easy to convince people at the Winnebago Tribe Powwow to talk about politics and the upcoming election. It's not only talking over the steady, infectious rhythm of the drum groups performing in the dance circle. There's often a sense that Native people get left off the radar of the people campaigning for office. In fact, if there's something everyone agrees on, regardless of political philosophy, it's that candidates need to make a swing through the reservation more often.

Will President Obama give a formal apology to Native people as nations like Canada and Australia have done recently?

Native American plaintiffs in a lengthy, class-action suit against the federal government say they're excited at the prospect of reaching a settlement with the new Interior Secretary, Ken Salazar.

The massive economic stimulus bill includes nearly three billion dollars for Indian tribes; that's more than the entire current budget of the Bureau of Indian Affairs. A good chunk of that will likely go to the Navajo Nation. As Arizona Public Radio's Daniel Kraker reports, tribal leaders there are desperate for funding for basic infrastructure projects.

Voting rights advocates are calling for congressional hearings into what they say is voter suppression on the Pine Ridge and Rosebud Reservations in South Dakota.

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