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."
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On the heels of a busy Montana legislative session, the advocacy group Western Native Voice is setting its sights higher and opening a Washington, D.C., office next week.
The nonprofit formed in 2022 to advocate for equity and opportunity for Montana's Native people. Since then, the group has gained members in, and collaborated with tribes across, many western states.
Keaton Sunchild, director of government and political relations for the group, said it can be difficult to operate at a national level from 2,000 miles away.
"Being able to be right there, be on top of the action and be able to use our voice in Washington is going to help us be a little bit more proactive," Sunchild explained.
He pointed out top issues at the national level include criminal justice funding for Missing and Murdered Indigenous People and drug crises disproportionately affecting tribal communities. Sunchild noted the national office will open May 12.
Sunchild called this year's Montana legislative session "pretty successful" for Western Native Voice but highlighted one area of continued concern is voting rights. Gov. Greg Gianforte is expected to decide Tuesday on Senate Bill 490, which would add restrictions to same-day voter registration.
"It's a road we've been down before," Sunchild acknowledged. "Trying to figure out the best way forward for that, whether that's through the courts in Montana, maybe if there's some sort of backstop we can look at federally."
Other voting access issues Sunchild plans to work on are funding for more satellite elections offices and blanket protections for tribal IDs as valid voter registration identification.
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Tourism generates $3 billion annually in North Dakota but tribal officials say direct spending from visitors does not always reach their areas. Now, a new grant program aims to help Native American tribes promote their sites.
Gov. Kelly Armstrong recently signed a bill which sets aside $100,000 for North Dakota's five tribal nations to share for tourism-related projects.
Kiera Fox, acting tourism director for the Mandan, Hidatsa and Arikara Nation, said it might not seem like a lot of money but it is a foot in the door. She noted her team can use it to improve signage and other needs, while promoting their history in a culturally-appropriate way.
"We get to tell our stories with our own voices," Fox explained. "Reeducate a little bit, correct some of those misconceptions everybody has about Native Americans."
She pointed out the MHA Nation is off the beaten path More visibility with signs might convince drivers to take a detour and check out sites, including a local museum and the Crow Flies scenic overlook. The bill sailed through the Legislature with minor opposition; however, the final sum is lower than the proposed $500,000.
Bill sponsors said the initiative benefits regional economies, with promotion from tribal and non-tribal areas working hand-in-hand. As for Indigenous communities, Fox emphasized having more tourists spend money locally expands their revenue base.
"For these businesses, some these entrepreneurs, our Native artists, they benefit," Fox stressed. "And then (there are) more funds going into infrastructure, updating our amenities."
Other tribes submitting testimony said Native entrepreneurs have difficulty working through issues like land use regulations, putting them at a disadvantage in becoming a tourism draw. The state Commerce Department does have other grant programs for local areas to promote themselves but tribal advocates said they are often out of reach for Native entities.
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Voter turnout from tribal communities in Wisconsin has increased in recent years, with historic numbers for the state Supreme Court election this month.
The Menominee reservation turnout increased by more than 80% from the spring 2023 election and both the Red Cliff and Bad River Bands of Lake Superior Chippewa saw turnout jump more than 60%, according to Wisconsin Conservation Voices, which works with tribal communities through its Wisconsin Native Vote program.
Maria Haskins, native regional tribal organizer for the group, said listening sessions, roundtables and regional dinners have been crucial in building relationships and getting people to the polls.
"With people seeing their peers being more active in the polls and becoming more informed about a lot of these issues, is what is really motivating them to go out and cast their ballot," Haskins observed. "Because I think that people are realizing their vote is their voice."
Haskins noted communities shared concerns at the events about issues like the opioid epidemic, which is severely affecting tribal communities, while drawing the connections of voting to their goal of tribal sovereignty.
The Menominee community has seen some of the most dramatic jumps in voter turnout. In 2023, community voting increased by 75% and has seen a 220% increase since 2019. Haskins believes the influx reflects the increase tribes are also seeing in representation, with more Native Americans running for office.
"I think that it's a huge movement," Haskins emphasized. "It's just something saying, 'Our people deserve to have a voice in what is happening, and we deserve to have the ability to be involved.'"
At a time when the country is seeing the rapid-fire dismantling of DEI initiatives and priorities, Haskins thinks it has never been more important to stay connected and involved.
"I'm super thankful for every community that we work in and I just can't express the importance enough of being in community and leaning on community right now," Haskins added. "I think that it's really important for all of us to have those connections and continue moving forward."
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