The state of Washington is helping Native Americans access health care after decades of barriers.

Health insurers have made it difficult for tribal members to get care covered, despite state and federal laws that bar this.

Vicki Lowe is the executive director of the American Indian Health Commission, which has led efforts to remove hurdles for Native Americans.

She said health insurers would try to make tribal clinics charge out-of-network rates, and wouldn't honor their referrals.

However, the Washington State Office of the Insurance Commissioner has come out with guidance to prevent this.

"Not only will tribes have more money to help pay for services for their tribal members, tribal members will get care in a more timely manner," said Lowe. "So those two things just are really important, and insurance companies have been a barrier for that for decades."

Washington is among the first states to move forward with guidance for insurers and also enforcement of the law so that insurers will stop putting up roadblocks for tribal members to get care in the state.

Todd Dixon is the deputy commissioner for consumer protection and the tribal liaison for the Office of the Insurance Commissioner.

He said one reason for releasing the guidance was that the agency has seen an uptick in complaints - the number one compliant typically coming from billing managers at clinics.

"It says, 'Hey, we have an enrolled member. He or she was seen at our clinic. We billed the insurance company. They said we're out of network and so "we're only paying 60%." And then they send a bill to the enrolled member,'" said Dixon. "It's not how it works."

The Insurance Commissioner's office has been sending notices to insurers who violate protections for Native Americans.

Lowe said before they got involved, tribes fighting with insurers on their own were getting them nowhere. But it's different with the state backing them.

"Knowing that if somebody violates these laws that they're going to get that outreach from the insurance commissioner and that they have 15 days to respond," said Dixon. "Where if a tribe asked them, they would maybe not respond or respond in some convoluted way - it's a power shift to really have the state agency behind this."

A new survey of Native American teens and young adults highlights a growing preference for the term "Indigenous" rather than being referred to as "American Indian."

Researchers from the Aspen Institute's Center for Native American Youth surveyed close to 1,000 Native Americans under age 24, including a large contingent from California.

Cheyenne Runsabove, associate director of youth programs at the center, said the term "Native American" is still dominant.

"Fifty-three percent of Native youth prefer the word 'Native American,' and only 7% prefer the word 'American Indian,'" Runsabove reported. "We continue to see that 7% going down, and what we continue to see uptick is the word 'Indigenous.'"

The report, called "Center Us," also found many Native youths are apathetic toward U.S. elections and disappointed in the rate of change. It also found Native youth who feel culturally educated are four times more likely to see themselves as capable of making a difference than those who do not.

Runsabove pointed out culture is identity for Native youth and noted more than 60% of California Native youth said they feel either moderately, a lot, or a great deal culturally educated.

"Language, history, stories, connection to land, all of those things are at the core of identity for Native youth," Runsabove explained. "And so, we have to be mindful of their true cultural identities."

The survey noted big differences between young people in urban areas versus small towns and reservations, when it comes to the availability of culturally-informed health care, after-school programs and money for college.


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The idea of revoking military medals awarded to soldiers at the Wounded Knee Massacre has gained traction recently, but some expect that to stop during the next administration.

During the 1890 Wounded Knee Massacre that took place on the present-day Pine Ridge Reservation, 25 U.S. Army men died and hundreds of Lakota people were killed.

Nineteen Army men involved were awarded Medals of Honor, the military's highest award.

Some say revoking military medals is a slippery slope, but others argue that recipients need to deserve the distinction.

On a South Dakota Humanities Council panel last week, Retired U.S. Army Major, professor, and military historian Dwight Mears said letting the awards stand is "objectively pretty offensive."

"Because," said Mears, "it inverted what essentially amounted to many, many crimes committed at Wounded Knee into an act of emulation, right?"

Various groups and lawmakers have called on the U.S. to reconcile this since the 1970s.

Mears said as the law stands now, Medals of Honor come strictly from the executive branch - and he said he doesn't expect any revocations to happen under President-elect Donald Trump.

In August, U.S. Sen. Mike Rounds - R-SD - and Sen. Elizabeth Warren - D-MA - asked that the Department of the Interior and the Department of Defense to allow more time for the review process.

But historian Brad Tennant said the event's historic nature makes that difficult.

Even the number of Lakota people who were killed is unclear. Estimates range from about 150 to more than 300.

"I think that's going to be the biggest challenge, to get beyond the guessing game and look at the reality," said Tennant. "Here we have a situation where several hundred individuals were killed and approximately two-thirds of them were women and children."

A U.S. Department of the Interior panel heard testimony from Lakota people and others in Rapid City in September.




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Montana has joined a coalition of Indigenous groups working to address Canadian coal mining pollution in the state's Kootenai River.

The International Joint Commission, formed in 1909, works to settle boundary waters differences between the U.S. and Canada. It has formed a governance body to take on the issue.

Tom McDonald, vice chair of the Salish and Kootenai Tribal Council, based on western Montana's Flathead reservation, said Canadian coal mines have been polluting the Kootenai for more than a century.

"To the point where the fisheries in Montana, as the watershed drains into Montana from Canada, it's caused fish to be deformed," McDonald explained. "Our native fish, like bull trout."

McDonald pointed out after years of stalled talks with Canada, the binational governance body will establish a cleanup plan for the 18,000-square-mile watershed over the next two years. One of the group's members is from Montana.

McDonald noted the runoff has affected the Kootenai River for nearly 400 miles into Montana and Idaho, and added the tribes finally resorted to involving the International Joint Commission to help. He emphasized selenium levels from the Canadian mines have reached the point where tribal members, who subsist on the fish in the river, cannot eat it.

"We don't know how far it's going into the food web," McDonald stressed. "We've been asking for Canada to fix the problem, enforce their regulatory laws against the coal mines, and they just haven't been able to do that. It's just elevated every year, and they keep expanding and getting bigger."

The Canadian company NWP Coal is proposing a new mine in the same watershed as the existing coal mines. The company claims its project will not increase selenium contamination but does not address the current pollution issue.


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