Indigenous Wire Q&A: U.S. Rep. Tom Cole on improving medical care for Native Americans
'In a polarized Congress, it's something that people can work together on and meet a genuine need.'
WASHINGTON – We recently sat down for an interview with Republican U.S. Rep. Tom Cole, of Oklahoma, to discuss his bipartisan, bicameral Medical Student Education Authorization Act, which would authorize the Medical Student Education (MSE) Program for five years.
The program is important to Indian Country because it provides grants to public higher education institutions to expand and support graduate education for physicians in states with the most severe primary care provider shortages.
“This legislation would benefit tribal health programs by increasing the number of Indian health providers and providing training to better serve American Indian and Alaska Native patients,” William Smith, chairman of the National Indian Health Board, said in a statement. “This bill provides grants to higher education institutions in states with severe health care provider shortages. The emphasis on partnerships between these institutions and tribal nations, integrating behavioral health into primary care, and addressing health equities will complement tribal nations’ efforts to enhance their health care delivery systems.”
U.S. Rep. Markwayne Mullin (R-Okla.), a citizen of the Cherokee Nation, said that people from his district often have to travel long distances to see their primary care provider at small, rural hospitals or Indian Health Servoce (IHS) and tribally-run facilities.
“Between the pandemic and shortages in our workforce, it’s getting harder for these facilities to recruit new physicians,” Mullin said in a statement. “The reauthorization of this program will help states suffering from primary care shortages and support an increase in physicians who are able to offer culturally competent care. Americans who live in rural and underserved communities deserve access to quality health care, and that’s why I’m proud to join my colleagues in introducing this bill.”
First created in 2019 by Cole and Republican Sen. Jim Inhofe, also of Oklahoma, the MSE Program is currently subject to annual authorizations from Congress, which results in significant uncertainty over funding and long-term planning for funded institutions, according to Congress members from both sides of the aisle.
In an interview with Indigenous Wire that quickly became wide-ranging, Cole — who’s a proud citizen of the Chickasaw Nation — explained the program and the problems facing it. He then went on to discuss the importance of bipartisanship, his concerns with Democratic leadership over bills affecting Natives, and the prospects of a legislative fix to the 2009 U.S. Supreme Court Carcieri decision, which impacted the Interior Department’s ability to take lands into trust for tribes.
He talked about a lot more than that, too — including what it feels like to be perceived as a White guy when his heart is so obviously Native, as well as his thoughts on inequitable pandemic relief funding distributions to tribes under both the Trump and Biden administrations, the importance of improving tribal infrastructure, the significance of the 2020 McGirt decision and ongoing battles surrounding it — which we plan to highlight tomorrow.
Let’s start out by talking about your Medical Student Education Authorization Act. You've got some strong bipartisan partners working with you in Congress on it. Who is it intended to help, and how it could positively impact Indian Country if enacted?
Absolutely. Just to give you a little history, this really started as a program, which we do on an annual basis in appropriations. And I designed it and put it in when I was chairman of the Labor, Health and Human Services Committee, and it's been maintained by my Democrat colleagues, because they like it, too. But the reality is we have a lot of underserved areas in the country…obviously, I think rural America, in general, is underserved. Indian Country, in particular, is underserved. So we were trying to address both these problems to get more medical professionals and attract more students, Native and non-Native from underserved areas, because they're more likely to go back to those areas. So we're trying to provide an attraction to do that. And we threw in the tribal component, obviously not to be parochial, but that fits Oklahoma pretty well, but also we work hard for Indian Country across the board in this office.
Talk more about the problems the legislation addresses, specifically for Indian Country.
I've been to a lot of reservations, and this is a huge problem. In many cases when you bring in outside staff, there's literally no housing for them, not much close, there. I'm not questioning their desire to be helpful, but it's usually quite often they're working through their student loans, they're providing service. They're not going to be there long term. We’re much better off if you can attract people from the communities. And we have some tribes — Cherokees in my part of the world — actually building a medical facility and school in connection, or in cooperation with, Oklahoma State University to address exactly this kind of problem and to get more Native Americans into the healthcare workforce, so to speak, from doctors and nurses, the healthcare professionals, all sorts, the idea that they're more likely to stay in Cherokee country, so to speak, if they've got a connection, and everybody I know is incentivizing healthcare professionals as much as they can.
So this is a program, particularly designed to help, again, more rural areas and particularly tribal areas where we just simply don't have enough healthcare professionals.
Lots of Republicans and Democrats are supportive?
I think it's very bipartisan again, when I put it in when I was chairman, I got great support from Chairwoman [Rosa] DeLauro, when she was the ranking member of the Labor, Health, and Human Services committee. People get the problem, and they want to be helpful. So actually in a polarized Congress, it's something that people can work together on and meet a genuine need.
The program is currently subject to annual congressional authorizations. Has it been well funded? Can you tell me more about the funding of it, and I assume you think it needs to be better funded?
Yeah, I think if we get an authorized program, I think we're more likely to get expanded funding…how much right now? Well, $50 million right now. So it's not an insignificant program. Again, we've been able to do something, but we'd like to expand it over a five-year period, give it more structure and hopefully build the funding over time.
Is it an especially important bill to you given the ongoing pandemic?
It absolutely is. I think the pandemic showed a lot of the cracks and the inequities in our healthcare system. We certainly saw it [with] African Americans, we [saw it] on the basis of income, we saw the difference between urban and rural, but probably no place more dramatically than in Indian Country. And so this program – and we're very active in the effort on telehealth as well, and broadband. You’ve got to work this problem from multiple angles, but the pandemic certainly showed the need. Again, we saw a lot of the problems before the pandemic. I'm sure you remember where we had a number of IHS facilities that the Centers for Medicare and Medicaid had to disqualify as hospitals on reservations, in the Dakotas and Nebraska, because again, there were a number of reasons, but one of them was, they just simply didn't have the appropriate personnel there to provide the services that are the trust responsibility of the United States government.
You note that this bill is pretty bipartisan and bicameral, so far, which Indian issues in Congress have tended to be over the years. Given today's overall partisan climate, do you feel like Indian legislation is getting any more partisan than it has been in the past?
I really don't. I'll give you an example unrelated to this topic, but there's probably nothing more partisan today than...you can call it voting rights legislation. I would actually call it voting rules legislation because it's really about the rules, not the rights. There's no question [about the] rights, but Democrats wrote a version, which hasn't gotten any Republican support whatsoever. Sharice Davids and Sen. Luján and I put together a Native rights voting bill that is bipartisan. And I think part of the reason we negotiated with one another routinely on these kinds of issues is that we have a common understanding, a common basis, but obviously there were politics involved in that. But again, we started out negotiating with one another, not one side writing it all by itself and then presenting it to the other side and saying, ‘Here do this.’ That's not going to work in this environment.
Is most Native American-focused legislation like that?
I mean, again, I don't think tribal issues fall along a Republican/Democrat axis at all. It always gets down to the tribal sovereignty and the trust responsibility. Those are the two main things. And if you understand those principles, you can build a bipartisan coalition. So the only voting rights legislation that could actually pass is actually the one that we wrote because it would be bipartisan. Now the problem tends to be that Speaker Pelosi will pick it up and put it with a partisan bill and merge it into...that's what she did with the old Indian Wellness Act, back in the Obamacare days. We had a bill that had really 300 co-sponsors and could have passed. She stuck it in Obamacare, and it lost — not only all the Republican support it had — it lost people like Dan Boren. Conservative Democrats have represented a lot of Indian Country.
I actually think if we can get leadership to let them move on their own, we can move a lot of Indian stuff, and it's tough, it's harmful. I always say, ‘Look, I can usually round up anywhere from 20 to 80 or more Republicans to support Native legislation.’ And if somebody's doing something that's harmful, I can usually get about that many people to vote no. And so some of the more egregious efforts to do that have come from some members that I think hurt Indians – I can break the Republicans. We brought down copper legislation two or three times in Arizona because it was a sacred sites issue. That's still an ongoing issue in Congress, but again, the basic point is yeah, I think on Native issues, the biggest problem is educating members that don't represent Native populations.
I'm not being critical of any of the other caucuses, but like the Hispanic caucus or the Black caucus are heavily...I mean, they're essentially exclusively Democrat. That's not true of the Native American caucus. We lost Dale Kildee this year, but that was how he set it up from the very beginning. And so again, we have members that will...I worked very hard when Mashpee was trying to make sure that the Trump administration didn't roll back its legislation. I got support on a Carcieri [fix]...voted for my own bill in the last Congress, Betty McCollom's bill...this time we got that out of the House.
How likely is it for a Carcieri legislative fix to the 2009 Supreme Court decision, which limited the Interior Department's ability to take lands into trust for tribes, to pass the full U.S. Congress any time soon?
It's been a Senate problem, not a partisan problem in the House. We’ve got lots of Republicans voting with lots of Democrats on that. So again, we can do these bills, we just need leadership to allow them to move forward. And we've got... okay, I have a wonderful relationship with Chairman Grijalva at Natural Resources. He's just a really good guy and he's great on these issues. And we've worked together many times on it. So you can get some birds of different colors, so to speak, to flock together here and help Indian Country. And this is a bill that I hope if it'll get scheduled, I'm quite comfortable we can get it passed.
This interview has been edited and condensed for clarity. Check in for part two tomorrow.
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