HOWNIKAN Giwségises | November 2020 Top photo: Brightly-colored leaves signal the changing of seasons at CPN. The Affordable Care Act turns 10 in 2020 Instead of a birthday party, the Affordable that do not have any cost sharing Care Act is getting oral arguments before requirements, such as co-pays or A LOOK INSIDE the U.S. Supreme Court that could lead deductibles, for in-network services. to its demise — and a lasting impact Page 4 on health care in Indian Country. Rather than wait for Medicaid expansion, the Citizen Potawatomi Nation Health The U.S. Supreme Court will hear Services launched a health insurance arguments in California v. Texas on pilot program in 2014 for uninsured Nov. 10. The lawsuit, known as Texas clinic patients who cannot receive afford- v. U.S. in the lower courts, specifically able health insurance coverage through challenges the ACA’s minimum Medicaid, Medicare or their employer. coverage requirements, more commonly A provision of the IHCIA permanent Remembering the Trail of Death known as the individual mandate. reauthorization that allows tribes to spon- sor coverage through plans on the ACA Attorneys general from 18 states, including marketplace made the program possible. Page 7 Texas, Kansas, Arkansas, Missouri and Indiana are seeking to have it struck down. In fiscal year 2019, the Tribe paid The federal government has sided with $751,304 in premiums for 213 patients, those 18 states and has indicated that including 99 CPN citizens. According to it wants most of the ACA’s provisions the CPN Office of Self-Governance, every eliminated. However, until the court dollar paid in premiums has generated issues a ruling, the Trump administration about $8 in savings on purchased and has continued to enforce the law. referred care costs from physicians CPN Health Services continues Colton Woodall poses for a photo with his outside of the Tribe’s health care system. to respond to COVID-19 Oklahoma is one of four states not parents, Brian and Keta Woodall, at their involved in any capacity on either home in Shawnee, Friday, Oct. 23, 2020. For Alesha Brewer’s family, the side of the lawsuit, along with Alaska, program has been a lifesaver, both Page 13 Idaho and Wyoming. According to the half of all American Indian children literally and figuratively. Kaiser Family Foundation, 148,474 are covered by Medicaid, according The true, dark history Both of Brewer’s daughters, 22-year- of Thanksgiving Oklahomans have health insurance to the Kaiser Family Foundation. through the ACA marketplace as of Sept. old Breanna and 18-year-old Cassie, 22. Ninety-five percent receive at least a Third-party billing, including Medicaid have a rare congenital condition that Pages 15-19 partial tax credit to help with the cost. and Medicare, brought in $1.14 billion impacts the connective tissue in their for IHS in 2019 alone. Those funds bodies. The condition could not even Tribal Executive and The litigation has also called into helped stretch the federal government’s be diagnosed without an appointment Legislative updates question the long-term viability of $5.8 billion appropriation for all IHS to see a geneticist after Breanna had the law, despite its targeted impact facilities and services. Since the adoption to have multiple shoulder surgeries. Page 20 on health in Indian Country. of the ACA in 2010, IHS’ Medicaid billing has increased by 21 percent. “We were constantly in the emergency Walking on “Repealing the ACA will exact a cruel room,” Alesha Brewer said. “We started toll on Indian Country,” Sen. Tom Udall According to a study published in getting sent to see specialists, which is (D-N.M.) said as part of an Oct. 15 December 2018 by the U.S. Government why we were called in about the insurance panel at the National Indian Health Accountability Office, the federal per program. Care was getting expensive.” Board’s virtual national conference. NON-PROFIT capita funding for IHS is less than half FIRST CLASS of what is provided to other government- Additionally, the condition requires STANDARD MAIL STANDARD “It’s important to realize and emphasize operated health care systems. IHS receives several medications that are not part ... that Native health is what’s at stake.” $4,078 per patient, compared to $8,109 of the standard IHS formulary, and typically, they costs upward of $1,000 for Medicaid patients, $10,692 for Among the provisions of the ACA per month without insurance. specifically aimed at Indian Country is patients seen through the Veterans Health the permanent reauthorization of the Administration and $13,185 for Medicare. Each daughter also has an additional med- PR SRT STD PR SRT US POSTAGE PAID US POSTAGE PERMIT NO 49 PERMIT PAID PAID PERMIT NO 49 PERMIT NO 49 PERMIT U.S. POSTAGE Indian Health Care Improvement Act. ical issue that requires even more medi- NON-PROFIT ORG NON-PROFIT STIGLER, OK 74462 STIGLER, OK 74462 STIGLER, OK 74462 PR SRT FIRST CLASS FIRST PR SRT As the vice chairman of the U.S. Senate cations outside of the standard formulary Initially passed in 1976, the IHCIA allows Committee on Indian Affairs, Udall ac- and come with a four-figure monthly bill. for Medicaid and Medicare funding to knowledged at the NIHB conference that Cassie Brewer also has postural orthostatic go to Indian Health Services. It also the ACA is imperfect, but its Medicaid tachycardia syndrome, which impacts the allows for tribally-operated facilities, provisions have been invaluable to IHS. including Citizen Potawatomi Nation body’s heart rate and circulation. Breanna Health Services’ two clinics, to collect “Remember the old saying in Indian Brewer has dysautonomia, which requires third-party billing. Prior to the adoption Country, ‘Don’t get sick after June intravenous fluids three times per week. of the ACA, IHCIA’s provisions were or July because there’s no more Participating in the program allowed subject to reauthorization by Congress, money?’ The Affordable Care Act … which last happened in full in 1992. the Brewer sisters to get diagnoses and added a lot more money into the made it possible for them to get regular, Indian Health Services,” Udall said. The law is also responsible for the federal prompt appointments with specialty government completely covering Medicaid “If you’re underfunded, you can’t providers that are often few and far and Medicare costs for patient visits do the things you need to do.” between on the contract health list. to IHS and tribally-operated facilities. As of September, Indigenous people Third-party billing is not just limited to If the insurance sponsorship program ends account for 10 percent of all Medicaid Medicaid and Medicare. IHS and tribally- due to a repeal of the ACA, the Brewer recipients in Oklahoma. In Pottawatomie operated facilities are able to bill patients’ family does not have a backup plan for County, the rate is even higher, with insurance providers, including those handling medical expenses or receiving 17.6 percent of SoonerCare and Insure purchased through the ACA marketplace. continual treatment for a condition that Oklahoma participants identifying as few Oklahoma doctors are familiar with. American Indian or Alaska Native. One ACA provision deems tribal citizens who earn up to 300 percent “I know contract health will give them Nationwide, almost one-third of of the federal poverty level eligible to the best care they can,” Alesha Brewer non-elderly Indigenous adults and choose health plans in the marketplace Continued on page 14 2 NOVEMBER 2020 HOWNIKAN Native land rights and the Land Runs of 1891 The Oklahoma land runs remain some Reenactments of the most notable events in the state’s history. The six that took place Representations of land runs in popular between 1889 and 1895 helped pave culture show a misleading series of events the way to statehood in November of and often dismiss Indigenous people. 1907. Many people associate them with “If you’ve ever seen the movie Far a feeling of excitement in the air as and Away, it’s just acre upon acre of pioneers and cowboys waited to claim rolling hills, and no one’s there, and their new property in uninhabited land. that really was not the reality for However, the reality was much starker. most of the land runs. … They were “Each one was a bigger disaster than the having to checkerboard through these next,” said Dr. Kelli Mosteller, director settlements of all of these tribal people of the Citizen Potawatomi Nation who had been there for 20-plus years Cultural Heritage Center. “Human at that point,” Dr. Mosteller said. nature comes into it. There’s greed. Public school curriculum, both in Land greed made the worst of human Oklahoma and across the country, fails nature come out. You had fights. You to discuss Native American land’s had people shooting each other. You dispossession. For some elementary had Sooners who were sneaking in and students, one of their first lessons in taking the plots of land and cheating.” Oklahoma history includes a reenactment The first land run took place on April of the Land Run of 1889. Dr. Mosteller 22, 1889, and established present-day refers to the oversimplification of Oklahoma City and Guthrie in one This map of Indian Territory shows the boundaries of tribal land Oklahoma’s statehood as a “disservice” that day. The Citizen Potawatomi Nation’s given through treaties prior to the Land Run of 1889. lends itself to the idea of Manifest Destiny. historical ties are with the Land Runs of “I think when you try to (teach) it 1891, which took place on Sept.