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Medicare and Medicaid Funding in Jeopardy

USET and other organization are asking for help lobbying for tribal consultation on the changes to Medicare and Medicaid funding to Indian country.  The rules have changed that leave it to State’s to set work requirements for eligibility for Medicaid funding through the 1115 waiver process.  This could severely impact Indian Health service funding.  Therefore AI/AN Medicaid recipients must be made exempt from these barriers to accessing the health care to which they are entitled, and CMS has a duty to ensure that this occurs as a part of the waiver process. Medicaid currently represents 67% of 3rd party revenue at IHS, and 13% of overall IHS spending.   Tribal organization are advocating that any proposed changes to the administration of Medicaid must be preceded by comprehensive consultation with Tribal Nations. Currently, the 1115 waiver process requires that states engaged in Tribal Consultation prior to submission of 1115 Demonstrations to CMS. CMS must ensure Tribal consultation with Tribal Nations occurs at both the state and federal levels before state waiver applications can proceed.

See USET Letter

 

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Fake News: It happens in Indian Country Too!

No doubt you have heard the news about the CEO and founder of Facebook, Mark Zuckerburg testifying on Capitol Hill, and explaining why he didn’t protect his Facebook subscribers from privacy breaches and those that promote false and fake news.  Well Indian Country is not exempt.  See Washington Post Article:

Well fake news happens about Indian Country too.  An article has been circulating on Facebook in recent weeks you may have seen published on May 5, with the headline, “In Victory for Standing Rock Sioux Tribe, Court Finds That Approval of Dakota Access Pipeline Violated the Law”.  That article was cut and pasted from an article a year ago.  A Vietnamese site claiming to be about Native American affairs has recycled the story to gin up clicks and advertising revenue. For some reason news about the Standing Rock reservation and Native American affairs in general have become a favorite niche of foreign-run Facebook pages and websites. If you see a news report about these topics pop up in your newsfeed, always check if you are looking at an original source before liking, sharing or commenting: it could be you are looking at old news being repackaged and fed back into your news stream by some guy in Macedonia or Kosovo wanting to make a few quick bucks.

Congress springs into action with an omnibus bill, and concerns rise about the 2019 appropriations

 

At the relief of Indian County Congress passes an Omnibus bill in March, holding the course and adding a little money to the Indian Affairs budget.  It was an uncertain, beginning to the year, that saw continuing resolutions, potential government shutdowns, a deal to raise budget caps, and a last-minute veto threat from the President.  At the end the legislation provides $1.3 trillion in omnibus appropriations for the remainder of Fiscal Year (FY) 2018.

 

Congressional appropriators rejected the deep cuts proposed in the President’s FY 2018 Budget Request, including those for federal Indian programs. Some of these provisions include:

  • Bureau of Indian Affairs (BIA): BIA is funded at a total of $3.01 billion, an increase of $203.8 million or 7.1%.
  • Indian Health Service (IHS): IHS is funded at a total of $5.5 billion, an increase of $497.9 million or 10%.
  • Victims of Crime Act (VOCA) Funding: The bill contains a 3% set aside for Tribal Nations within the VOCA fund, or $133 million for the delivery of victim services in Indian Country.
  • Opioid Epidemic: From a total of $1 billion in new grant funding to address the opioid crisis directed at state and Tribal governments, $50 million is set aside for Tribal Nations. In addition, $5 million is set aside for Tribal Nations to provide medication-assisted treatment. Finally, $7.5 million is provided for the BIA’s  Law Enforcement Opioid initiative.

Significant increases:

  • Infrastructure: spending would increase for BIA and IHS construction, BIA road maintenance, and a $100 million competitive grant program is added under Native American Housing Block Grants (NAHBG) in addition to the $655 million provided for the NAHBG formula grants.
  • Road Maintenance: will receive a 14 percent increase to $34.6 million.
  • Restoration of the Tiwahe initiative: at the fiscal year 2017 enacted level.
  • Violence Against Women Act: $2 million to implement both training and specific Tribal court needs, and $13 million to address the needs of Tribes affected by Public Law 83- 280.
  • BIA Construction: would increase by $162 million to $354.1 million, an 84 percent increase.
  • Opioid initiative:5 million for the Bureau of Indian Affairs Law Enforcement.

See Link: Budget Report

An interesting strategy has been proposed this last week to handle 2019 appropriations bills.  Nearly, 16 Republican senators announced a willingness to work through August recess to complete spending bills and confirm more of President Donald Trump’s nominees. Sen. David Perdue of Georgia, who has led the effort, hinted that a letter to Majority Leader Mitch McConnell of Kentucky would be forthcoming. “The Senate should immediately begin work on one or several consolidated appropriations bills, so they can be openly debated and amended accordingly,” the senators wrote. “Our defense priorities are bipartisan, and they should come first.”

That letter signals a willingness by the conservatives to bundle spending bills together, perhaps using the “minibus” strategy in which several regular appropriations measures get combined on the floor. Normally, senators would not want the chamber in session well into August during an election year, with lawmakers eager to be home and meeting with constituents and voters.  The Republicans seem to want to avoid a last minute continuing resolution to keep the government funded past the end of September and they want to confirm a large number of Trump nominations as August approaches. Some of the 77 confirmations that took place by unanimous consent or voice votes as the August recess got underway in 2017 might have happened without a cancellation threat since that’s been the normal practice of the Senate.

These 16 senators, however, believe the threats affected the behavior of Senate Democrats. “Our diligence was rewarded with reason, and that can happen again,” the senators wrote.

See Article

Meanwhile dozens of Indian Country leaders were on Capitol Hill last week to present their budget priorities to key members of Congress before the Appropriations subcommittee on Interior. The testimony from tribes and Indian organization, representing every region of the nation, had a consistent message – Indian Country needs additional funding as part of the federal government’s trust and treaty responsibilities. The panel’s Republican and Democratic leaders, for the large part, have embraced that goal.
After hearing from the tribal witnesses, the House Appropriations subcommittee on Interior will spend the next month or so drafting the Interior appropriations bill. The package is typically released sometime in June, with lawmakers aiming to get it passed before October 1, the start of fiscal year 2019.

Update on Senate Committee Chairs and their Agenda for the New Congress

New GOP Senate Chairs Aim To Undo Obama Policies

Posted: 01/03/2015 8:16 am EST Updated: 01/03/2015 10:59 am EST
PAT ROBERTS

With Republicans winning control of the Senate in the November election, all the committees will get new leaders, though all have been around for years.

The heads of the 13 major committees and Veterans’ Affairs are some of the most senior members of the Senate. Three are octogenarians and four are in their late 70s. Only one new leader will be a woman; Alaska Sen. Lisa Murkowski is in line to take over the Energy and Natural Resources Committee.

A look at the powerful senators and their issues:

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AGRICULTURE

Kansas’ Pat Roberts, 78, will consider renewal of child nutrition programs that have been pushed by the White House and expire next year. Roberts has criticized efforts to make school lunches healthier, calling for studies on the costs of the program and economic impact on schools.

Roberts has been a recent dissenter on the normally bipartisan panel, voting against the five-year farm bill that Congress passed in May. Roberts supported the bill’s boost in crop insurance for farmers but said other subsidies needed more changes. He called the entire bill “a look in the rear-view mirror.”

Like his Republican counterparts in the House, Roberts has championed cutting back spending for food stamps, saying the farm bill’s estimated cut of $8 billion over 10 years was insufficient.

Roberts held the gavel of the House Agriculture Committee 20 years ago and during his tenure he helped write the 1996 farm bill.

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APPROPRIATIONS

The gavel of the powerful panel responsible for drafting approximately one-third of the federal budget will return to Mississippi’s Thad Cochran, who turned 77 in December and was just re-elected to a seventh term.

Cochran was in charge during the last two years of the previous GOP majority and was a driving force behind more than $100 billion in funding to help Gulf Coast states recover from Hurricane Katrina. He was also a big practitioner of earmarks, those home-state goodies such as highway projects, economic development grants and university research dollars.

GOP leaders have banned earmarking, but Cochran is sure to back Navy shipbuilding efforts. Ingalls Shipbuilding in Pascagoula, which makes a variety of Navy ships such as modern destroyers, is Mississippi’s largest private employer.

Republicans are expected to use the 12 spending bills to challenge Obama on policy issues, such as health care, financial services, immigration and the environment.

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ARMED SERVICES

Leading the committee has been a long-sought goal for 78-year-old John McCain of Arizona, the former Navy pilot, Vietnam prisoner of war and two-time presidential candidate who lost to Obama in 2008.

McCain, who has hinted he might seek a sixth term in 2016, stands as one of Obama’s fiercest critics on national security, casting the administration as weak and ineffective in countering threats overseas. He has repeatedly called for arming and training moderate Syrian rebels and favors more U.S. forces in Iraq to battle Islamic State militants.

McCain has been critical of Pentagon contracting. Increased examination of defense manufacturers and acquisition policy is certain. The Pentagon can largely forget about scrapping the A-10 Warthog aircraft, which McCain heavily favors, and can expect close scrutiny of the costly F-35 fighter jet.

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BANKING, HOUSING AND URBAN AFFAIRS

The wily Richard Shelby, 80, makes a return tour as head of the committee. High on his agenda will be changes to the financial overhaul law enacted in response to the 2008 crisis, known as Dodd-Frank. The 2010 law that brought stricter regulation of banks and Wall Street has been a burr in the side of Republican lawmakers, and the GOP-controlled House has passed numerous bills to unwind it.

Sen. Mitch McConnell, R-Ky., the next majority leader, put it plainly at his day-after-the-election news conference: “The Banking Committee is certainly going to look at Dodd-Frank.” The big banks, he said, “are doing just fine under Dodd-Frank. The community bankers are struggling.”

Besides bank rules, the committee under the Alabama senator also may focus on curbing the authority of the Consumer Protection Financial Bureau over auto lenders and credit card companies. The bureau was created by the financial law.

Also likely to get committee attention is legislation to reshape the housing finance system and wind down mortgage giants Fannie Mae and Freddie Mac.

Shelby succeeded as head of the panel from 2003 to 2007 in blocking bank regulation proposals.

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BUDGET

In a surprise, Wyoming’s Mike Enzi will become chairman of the Senate Budget Committee after Jeff Sessions of Alabama stepped aside. Sessions had been the top Republican on the committee the past four years.

Enzi, 70, said he will work to craft a budget “that cuts spending, targets executive overreach and reduces the size of government.”

He will be called upon to craft a budget framework that could serve as a template for follow-up legislation to repeal Obama’s health care law and, perhaps, tackle expensive benefit programs such as Medicaid and food stamps.

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COMMERCE, SCIENCE AND TRANSPORTATION

South Dakota’s John Thune, 53, faces a heavy workload — reauthorization of the Federal Aviation Administration and Amtrak, net neutrality and transportation.

The committee will have to address the auto safety portions of the highway bill in the aftermath of General Motors faulty ignition switch recalls, now linked to more than two dozen deaths, and the Takata air bag recalls, also linked to several deaths. Proposals to toughen federal oversight of the auto industry are likely. Some lawmakers have called for eliminating the $35 million cap on how much the government can fine automakers in such cases.

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ENERGY AND NATURAL RESOURCES

An energy policy expert from an energy-producing state, the 57-year-old Murkowski wants to unlock as much of America’s energy as safely possible.

Murkowski has argued for opening up the Arctic National Wildlife Refuge for drilling, as well as Alaska’s offshore, and has opposed regulations that block energy production. She believes EPA regulations to curb coal-fired power plant pollution to deal with global warming will threaten the reliability and raise the costs of electricity.

She supports exporting U.S. natural gas and has led the charge on pressuring the administration to lift restrictions on exports of crude oil. She has backed the immediate approval of the Keystone XL oil pipeline, which McConnell has said will be first on the new agenda.

Murkowski, unlike others in the GOP, believes global warming is happening and that Alaskans are already experiencing the effects of rising water temperatures and thinning ice.

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ENVIRONMENT AND PUBLIC WORKS

The likely ascent of Oklahoma’s James Inhofe, 79, represents one of the biggest sea changes on a Senate committee with Republicans in charge.

Inhofe, one of Congress’ most vocal deniers of the scientific consensus of climate change, wrote in a 2012 book that global warming was “a hoax.” He will replace Californian Barbara Boxer, who introduced climate change legislation in 2009 and was an ally of the environmental community and Obama.

Inhofe, by contrast, is a thorn in the side of the Environmental Protection Agency and has argued that more regulation will kill the economy and jobs. Inhofe has called on the EPA to abandon stricter rules on refinery air pollution and to reject their own scientists’ recommendation to tighten a standard for the main ingredient in smog. Inhofe is likely to boost oversight of the agency and try to thwart its agenda at a time when Obama wants to shore up his climate legacy.

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FINANCE

The 2010 health care law is in the GOP’s crosshairs, and Utah’s Orrin Hatch, 80, is likely to use his position to take the first step at chipping away at it.

Hatch has called the law’s tax on medical devices “stupid” and is determined to roll it back. He is likely to gain some Democratic support for the effort.

Hatch could be a free-trade ally for Obama if the president pushes more trade agreements.

Overhauling the nation’s complicated tax laws also is a priority for Hatch. But it’s a heavy lift.

Administration officials say Obama will offer new specifics in the coming year on how he would like to reshape corporate taxes, which now feature the highest rate in the industrialized world. But bridging the divide between Republicans and Democrats on major tax legislation would require a level of bipartisanship that has largely been absent during Obama’s first six years as president.

Hatch has worked with Democrats in the past; his friendship with the late Sen. Edward Kennedy of Massachusetts is legendary. Hatch will need to work with Democrats again if he is to advance an overhaul of the tax code.

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FOREIGN RELATIONS

Tennessee’s Bob Corker, 62, has criticized Obama’s foreign policy as tepid in dealing with Russia, Libya and Syria. Like several other Republicans on the committee, Corker has deep reservations about the administration’s negotiations with Iran over its nuclear program. Some Republicans have said the GOP will push new penalties this month that target Tehran.

Secretary of State John Kerry has asked Congress for new war powers in the fight against the Islamic State group. Corker has raised the possibility that he could work with the administration on the issue.

Obama’s ambassadorial picks and other nominees would face a rough outing before the committee.

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HEALTH, EDUCATION, LABOR AND PENSIONS

Tennessee’s Lamar Alexander, 74, is a former education secretary under President George H.W. Bush, governor and president of the University of Tennessee.

A lawyer by trade, he helped form a corporate childcare company in the private sector. Alexander said he wants to fix President George W. Bush’s No Child Left Behind education law that’s been due to be renewed since 2007 and update the Higher Education Act.

He’s called the health care law a “historic mistake” and supports repealing it. He’s also said modernizing the National Institutes of Health and Food and Drug Administration is a necessity, and he is seeking to examine the FDA’s process for drug and device review. On workers’ issues, he’s sought to turn the National Labor Relations Board into what he says is more of an umpire role.

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JUDICIARY

A farmer, not an attorney, Iowa’s Charles Grassley, 81, has been on the Judiciary Committee since his 1980 election to the Senate. But this will be his first stint as its chairman.

In that post, many expect him to continue his long-running interest in protecting whistle-blowers who reveal details of alleged fraud by government contractors and others. He’s also expected to continue oversight of programs like the Justice Department’s bungled “Fast and Furious” operation, under which federal agents lost control of guns they were tracing to Mexican drug lords. Many also expect him to work on legislation easing federal regulations on businesses.

Grassley opposed last year’s Senate-approved bipartisan immigration bill, arguing that it needed to do more to secure the country’s borders before granting legal status to people in the U.S. illegally. He’s also pressed for more information about the National Security Agency’s ability to gather information on Americans, though he’s cautioned that the agency must be able to protect national security.

A decade ago, Grassley spent time as chairman of the Senate Finance Committee and played a role in winning approval of President George W. Bush’s 2001 tax cuts and the 2003 addition of prescription drug benefits to Medicare.

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HOMELAND SECURITY AND GOVERNMENTAL AFFAIRS

Wisconsin’s Ron Johnson, 59, has been a tough questioner of administration officials about the deadly 2012 attack on the U.S. diplomatic outpost in Benghazi, Libya. The question will be whether the panel’s Permanent Subcommittee on Investigation opens another Benghazi inquiry in Congress as well as other reviews of the Democratic administration.

Under the leadership of Delaware Democrat Tom Carper, the committee focused primarily on the internal workings of the sprawling Homeland Security Department, including low morale ratings from rank-and-file employees and contracting issues.

Johnson has focused on those rankings in the past and led an investigation of complaints from whistle-blowers about the department’s former acting inspector general. His report, co-authored with Missouri Democrat Claire McCaskill, prompted DHS Secretary Jeh Johnson to suspend the former top internal investigator.

While the committee has addressed immigration issues in the past, senators on this panel have not taken as prominent a role as their counterparts on the Senate Judiciary Committee. In the coming months, however, any administrative changes put in place by Obama are almost certain to be reviewed.

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VETERANS’ AFFAIRS:

Georgia’s Johnny Isakson, 70, has stressed mental health needs of veterans and voted in favor a bill to provide two-year funding for veterans’ benefits, so veterans would continue to receive benefits even in a government shutdown.

Aides say Isakson’s priorities as chairman would include oversight of the new Veterans Access, Choice and Accountability Act of 2014, which was approved this past summer in response to a scandal over long wait times for veterans seeking health care and falsification of records to cover up delays.

Isakson strongly supports a provision in the law that makes it easier for veterans to seek Department of Veterans Affairs-paid care from local doctors. Bringing competition into the VA health care system will improve services, he says. Isakson also said the new law provides an opportunity for the VA to assess the quality of it leadership and management, and said underperforming executives and managers should be fired.

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Associated Press writers Andrew Taylor, Kimberly Hefling, Joan Lowy, Alan Fram, Marcy Gordon, Matthew Daly and Alicia Caldwell contributed to this report.

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