Photo: Susie Billie collecting medicinal plants: Big Cypress Seminole Indian Reservation, Florida, 1985, Florida State Archives, Wikimedia Commons
In the late 1980’s and 90’s, there was a time in the State of Arizona where native people were being blatantly discriminated against by politicians loyal to themselves and then Governor Evan Mecham. Times are the same now in many ways.
I was working for the Arizona Health Care Cost Containment System (AHCCCS) as the legislative liaison for Arizona Indian Tribes in Arizona. It was a great job, but there were some very crucial unresolved ongoing decision points for our dear native people (For those not familiar, AHCCCS is basically Medicaid).
The issue at the time was whether to include Arizona Indian Tribes in the new AHCCCS 1115 demonstration project being reviewed and approved statewide by the Arizona State Legislature.
Anti Indian factions took the arbitrary uninformed position that Native Tribes in Arizona had the Indian Health Service available for health care, and therefore, the State of Arizona was not legally or financially responsible for health care to tribal members living “on reservation” in Arizona.
Pro Indian factions took the definitive and informed position that Medicaid was an entitlement program by federal law, and therefore, Arizona Indian Tribes and citizens were entitled to such care, similar to any other citizen of the State of Arizona.
During this critical time there were only two native senators in the Arizona State legislature – one of whom was Mr. Jack C. Jackson Sr., from the great Dine’ Nation. Amidst political posturing, tactics, strategies and stupidity to intentionally leave native people out of AHCCCS health care coverage, Mr. Jackson stood firm in his official capacity as an elected official and Dine’ leader stating that native people were entitled to AHCCCS health care coverage as citizens of the State of Arizona.
During this crucial time, the State of Arizona held many meetings among the Governor’s Office and the Republican caucus to prevent native participation in AHCCCS. Rather than negotiating in good faith, or facilitating agreement between the State and Tribal Nations, the State hired a team of lawyers to seek ways to absolve their legal and financial responsibility to native people, and intentionally leave our dear people out of AHCCCS coverage.
As always, the critical factor was money. The State did not want to pay the state match of 32% to receive the remaining 68% from the federal government to fund the “on reservation” AHCCCS coverage. Total AHCCCS funding was in the millions of dollars when combining the total state and federal matching funds in the 1115 waiver. Millions of Arizona citizens would benefit, but not native people, if they had their way.
A standard approved funding formula was used nationwide by the Center for Medicaid and Medicare Services (CMS) for Medicaid service development. Rather than agreeing to this funding formula, the Arizona legislature took a racist position - based on your native race and where you live in Arizona, we politicians are deciding for you that you cannot receive AHCCCS health care. I remember sitting in the State legislature when one republican state senator took the floor and shouted, “Why should we pay for them damn Indians health care.” There was actually applause from some elected officials on the floor and people in the gallery.
As a Dine’ leader, Mr. Jackson was clearly outnumbered by fellow senators. The Governor’s Office and the Republican controlled state legislature clearly opposed his position for the people. The Governor had previously appointed the AHCCCS director, a republican also. His appointment was clearly meant to stack the deck against Native people, not only legislatively and legally, but also administratively, by appointing a fellow republican to head AHCCCS.
Mr. Jackson continued to stand up for what was right and advocate for native people despite the odds. We had a great professional relationship, were related by clan, and most of the time talked about things other than AHCCCS and politics. Rodeo, basketball and Native American Church were our topics. He had a great sense of humor and would tease me big time in a friendly manner. I looked up to him, respected him and supported him the best I could in day-to-day tasks and strategies. Through our interactions on AHCCCS, we decided - if the republicans can strategize, so could we. Although I worked for AHCCCS and the State of Arizona at the time, I was a Dine’ in my heart, mind and soul. Through prayer and discussions, Mr. Jackson and I came up with a plan to present a realistic solution.
We identified and engaged our powerful constituents – the 22 Arizona Indian Tribes. We identified our legal foundation – 42 CFR which clearly states Medicaid is an entitlement program for eligible people, regardless of ethnicity or residential location. We identified the Indian Self-Determination and Education Assistance Act (P.L. 93-638) and the Indian Health Care Improvement Act (P.L. 94-437) as the federal laws and foundation of Tribes nationwide. These federal cornerstones of Indian law had much more legal authority, flexibility, and clout than a state legislative governing body.
Creator works in mysterious and blessed ways. It turned out the Governor’s appointee for the AHCCCS directorship, Dr. Leonard J. Kirschner, was of Jewish origin, a good guy, and very empathetic to native people. He tried to be a hard liner in public, but in private, he was a softie with a kind heart for native people.
Within the AHCCCS structure, the most critical service needed by elderly tribal members is long term care. Dr. Kirschner hired Dr. Mabel Chen as director of the Arizona Long Term Care System (ALTCS), a major division of AHCCCS. Dr. Chen was of Chinese origin and very respectful to tribal sources. Deep down, I think she understood what really was going on regarding blatant discrimination against native people by the Governor’s office and state legislature, because she may have experienced it herself.
So, what do we do for the people? In a brilliant move, Mr. Jackson introduced legislation to create the Advisory Council on Indian Health Care, which was surprisingly approved by the State legislature. This state law and Council gave tribal officials input in the system, or non-system if you will. Rather than lowering Tribal Nations to the level of a state government, Mr. Jackson and I recommended to all an Intergovernmental Agreement approach between the State of Arizona and sovereign Arizona Tribal Nations.
We brought together advocates, health care directors, and tribal lawyers to begin drafting an intergovernmental agreement from a knowledgeable tribal legal and health care perspective. It was an eye-opening learning experience for some Arizona state legislative representatives, who had never heard of the Indian Self-Determination and Education Assistance Act (P.L. 93-638), the Indian Health Care Improvement Act (P.L. 94-437), or Intergovernmental Agreements. Do these federal laws really exist was the question from non-tribal sources? Yes, they do. In fact, they existed since 1975, when AHCCCS or the 1115 waivers did not exist.
Over a period of several months, Mr. Jackson presented his case for Native inclusion and civil rights in AHCCCS consistently and compassionately. He presented before the U.S. Congress, Arizona State Legislature, Navajo Nation Council, and other tribal councils, speaking from his heart and exemplifying his commitment to various audiences on many occasions. He was our entitlement to health care Chief, standing strong.
At work I took it upon myself to get to know the AHCCCS attorney, Mr. Logan Johnston, another good guy. Specifically, his knowledge of tribal sovereignty and related federal law. He had to tow the state line, but as we went forward on this important tribal issue of inclusion in health care coverage, he began to understand our sovereign tribal perspective. Simultaneously, the draft of the Intergovernmental Agreement was being developed by tribal sources and lawyers in a collective cooperative manner.
On purpose, I often scheduled these tribal lawyer meetings in the Director’s Conference Room at AHCCCS headquarters on 7th Street and Jefferson in Phoenix, Arizona. The racist types didn’t like it. Natives in the house talking about self-determination, civil rights, and health care coverage right in our AHCCCS Director’s Conference Room!
After 27 drafts of the Intergovernmental Agreement were shared, debated, and edited between the state and tribal lawyers over several months, a deadline to decide was now due – include native people in AHCCCS or not. So, we scheduled one last meeting of the teams of lawyers from both sides. Again, I scheduled it at AHCCCS headquarters on a Friday afternoon. I facilitated the meeting and counted 21 state and tribal lawyers in the room. It was stuffy. Mr. Jackson was quietly sitting next to me keenly observing and listening to state lawyers, like a Chief listening to naughty children who knew better.
The meeting went past 5 p.m. and despite attempts to negotiate, the lawyers remained at a stalemate, no agreement on the IGA. I could see that Mr. Jackson was not satisfied with the progress of the discussions, so he suggested all staff leave the conference room and have the lawyers talk directly among themselves. One lawyer on the State side said it was 5 p.m. and recommended to adjourn and reconvene the meeting next week. Old lawyer trick. What he really meant was we don’t want to agree and there will be no meeting next week. No meeting next week, no Native coverage.
It was now about 5:30 p.m. on a Friday evening and most AHCCCS daily staff had left the building. Complying with Mr. Jackson’s suggestion, all staff left the conference room. Mr. Jackson and I were last to leave. I will always remember as we were walking out the room, something told me to lock the door to the conference room behind me with the 21 lawyers inside. I locked it with my key from the outside, so no one inside could get out until they all came to agreement. Old Native trick. What I really meant was you are going to meet and agree, until my Native people are covered.
A few minutes later, I received a call. “What are you doing!” the state team lawyer yelled at me in a frantic voice as Mr. Jackson and I sat in my office a few doors down from the conference room. Reflecting, Mr. Jackson and I felt a little rez humor, locking the big-time state lawyers in the room with the fired up tribal lawyers, and getting yelled at on the phone.
At that time and moment, it was also very serious, given the deadline, participants, diverse legal opinions, financial stakes, special interests and Tribal Nations all in that locked conference room. After walking to my office and sitting at the round table near my desk, Mr. Jackson and looked at each other and didn’t have to say a word. He was probably thinking “I’m going to get it from the legislators and Governor’s office.” I was thinking “I am probably going to get fired.”
I answered the call and stated, as respectfully as I could “Come to an agreement and we will unlock the door.” Needless to say, this response made the state lawyer angrier. We sat and wondered what was going on in the room. At around 7:45 p.m. that evening, I got a call from Mr. Logan Johnston to open the conference room door.
His smile gave him away. Mr. Jackson and I walked toward the conference room filled with weary looking lawyers in suits, some with ties undone. It was stuffy. After almost a year of back and forth, the state and tribal lawyers finally agreed to an Intergovernmental Agreement that included native people in health care coverage at 22 Arizona Tribal Nations, the Indian Health Service and Public Law 93-638 hospitals and facilities statewide.
It was a cumulation of prayers, hard work and perseverance by all tribal advocates. Most importantly, it was a blessing from God Almighty, a resounding triumph and validation of tribal sovereignty by finally including thousands of needy tribal citizens in a program meant for all. In 2024 there are 3 million eligible members of AHCCCS, with all tribes participating. Without a doubt, this outstanding accomplishment and recognition of native people was led by Mr. Jack C. Jackson Sr, as an Arizona State Senator and God Almighty’s trusted servant.
Reflecting back, I am almost certain that AHCCCS officials Dr. Kirschner, Dr. Chen, and attorney Logan Johnston were secret tribal advocates as State employees in their own special and kind way. They very easily could have been obstacles but were in fact facilitators to recognition of tribal sovereignty and Tribal Nations. And by the way, thank you for not firing me. We were a great team.
There are many great stories and memories of Mr. Jackson, who made his journey on March 5, 2023. His love for the people. His Dine’ inspired technical expertise, strategic Native mind, and leadership. His humor and kind heart. When you are stepping up to patient registration or getting your AHCCCS card out at a tribal or Indian Health Service facility, to receive health care for you or your children, think of this great man who made it possible.
With the recent recognition of Native American traditional healing as an approved and reimbursable service through an 1115 waiver by the Center for Medicaid and Medicare Services in California, Oregon and other states, it is my duty and responsibility to share this story of a man who planted the seed in Arizona over 30 years ago for this service. Thank you, Mr. Jackson, for your advocacy and commitment to native people during your illustrious career as an Arizona State Senator and life of service. With all due respect, this is a story that must be shared with all Dine’ and Indigenous people. Thank you for being a true Chief of the people, Mr. Jack C. Jackson Sr.
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