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  • Writer's pictureHarold C. Frazier

Frazier: Build Back Better is taking care of the middle class and most vulnerable among us

White Horse, South Dakota

As Chairman of the Great Plains Tribal Chairmen’s Association, it’s been heartbreaking to see the devastating toll that COVID-19 has taken on Indian Country. Across the nation, our communities have seen considerably higher levels of COVID-19 infections and deaths since the spring of 2020 relative to the overall population.

Although the Indian Health Service and community leaders have done well in getting American Indian communities vaccinated against COVID-19, we will still be grappling with the long-lasting impact of COVID on survivors and victims’ families in the months and years to come.

The long-term challenges presented by COVID make it even more important to ensure that American Indians can access and afford the health care coverage they need. Unfortunately, health care remains out of reach for too many of our people today, in part because 12 states (South Dakota included) have refused to expand Medicaid coverage under the Affordable Care Act. There’s no better time than now for Congress to expand access to Medicaid as part of the ongoing budget reconciliation process, which would ensure that Indian Country and all Americans have health care we can rely on and are better prepared for other public health challenges in the future.

Although the Indian Health Service provides health care regardless of insurance status, accessing affordable health care services has continued to be a challenge in many Native communities. For those in more rural areas, the closest IHS facility may be too far to travel to for preventative care and other non-emergency services. What’s more, some patients may not be able to see an IHS provider in a timely manner due to limited resources and capacity. Without the right health coverage, our Indians have few options when it comes to health care - and the consequences are seen in the persistence of chronic health issues in our communities like obesity and substance abuse disorders.

Native Americans have some of the highest uninsured rates in the country, and are almost three times less likely to have insurance than white Americans. Although the ACA has helped lower uninsured rates among Native Americans from almost 30 percent to 20 percent between 2013 and 2018, thousands of our relatives in South Dakota and other states remain uninsured. Medicaid already covers more than a quarter of non-elderly American Indian adults and half of our children, but thousands more are losing out on this crucial lifeline because their state lawmakers have failed to expand Medicaid. For many of these individuals, their incomes are too high to qualify for Medicaid, but they still don’t make enough money to afford private insurance. They have fallen through one of the cracks in our healthcare system, known as the Medicaid “coverage gap.”

For years, health care advocates have urged state governments to change course. Many South Dakotans are working to advance a ballot measure to let voters directly approve Medicaid expansion, but the South Dakota political establishment has responded by trying to make it harder to approve ballot measures. Refusing to take advantage of this life-saving policy in the name of partisan politics. The Build Back Better budget resolution currently being considered by the House of Representatives provides a path for Americans denied access to Medicaid in these states to obtain health coverage and help close the coverage gap.

Closing the Medicaid coverage gap would help our communities recover from the impacts of COVID-19 and help reduce disparities in health outcomes. We know that there is high demand for Medicaid access among Native communities because after Montana approved Medicaid expansion in 2016, over 15,000 newly eligible tribal members decided to enroll. These people gained access to essential services that allowed them to seek treatment for ailments common in Indian country and get the care they needed during the pandemic.

Expanding access to Medicaid would also help improve the quality of care at IHS facilities, which often go underfunded. The IHS and tribal facilities located in Montana’s Blackfeet Reservation received an additional $13.6 million in federal reimbursements within eighteen months after their state’s Medicaid expansion, which helped them provide care to thousands of additional people. The reality is that increasing access to health insurance coverage is not only better for patients and their communities, but for health care providers as well.

Expanding health care coverage is crucial for ensuring everyone can get the care they need, no matter where they live or how much money they make. Congress must pass the Build Back Better budget proposal to finally close the Medicaid coverage gap and help Indian Country heal and rebuild as we emerge from this public health crisis. Hecetu elo.

About Harold C. Frazier

Harold C. Frazier is serving in his fourth term as Chairman of the Cheyenne River Sioux Tribe, a federally recognized, sovereign Indian tribe located in South Dakota. Mr. Frazier also serves as the Chairman of the Great Plains Tribal Chairmen’s Association (GPTCA) which is made up of 16 tribal Chairmen and Chairpersons from North Dakota, South Dakota and Nebraska. Frazier is a lifelong resident of White Horse, South Dakota, and holds concurrent leadership positions with the Great Plains Tribal Chairmen’s Health Board, and Dakotans for Health.

About Dakotans for Health

Dakotans for Health, an emerging group of public officials, caregivers, health care advocates, and concerned citizens to improve healthcare in the Dakotas including sponsoring the expansion of Medicaid and defending South Dakota's century old tradition of the initiated measure. We are honored to be joined by Organized Labor, all nine of South Dakota's Native Nations, and AFSCME Council 65 in this worthy endeavor.

Questions? Contact Pam Cole [] she is our Grassroots Organizing Director and will take good care of you!

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