There will be a vote to at least repeal the Affordable Care Act this week. And perhaps replace it, too. But what the bill looks like is unclear. But three inter-tribal organizations say the changes in one Senate bill would change the funding formula for Indian health and a “radical departure from over 40 years of federal policy.”

The Senate healthcare bill looked like it was going to pass last week. Now the process is on hold for at least another week. Sen. John McCain’s office announced he will be in Arizona recovering from surgery. The support for this healthcare bill is so thin that it’s impossible to round up a majority without him. So the Senate will wait.

The Senate is back this week and Republican leaders are once again looking for votes for their health care plan. It’s a tough sell for lots of reasons. The bill tips towards conservatives and moderates say no. Rewrite the language so that moderates are happy -- and the conservatives bolt. And it only takes three GOP no votes for this bill to fail.

Both the Senate bill, and the House counterpart, are supposed to be about repealing the Affordable Care Act. But for Indian Country there is something else at stake, jobs.

The Senate bill is not about health care. It’s a tax cut, one that’s paid for by destroying Medicaid. Medicaid -- a public insurance program for people who are poor or disabled -- makes up about 20 percent of the Indian health system budget.

The Standing Rock Sioux Tribe and the Cheyenne River Sioux Tribe won a court case against the Dakota Access Pipeline project last week. The ruling affirmed the tribes’ treaty rights, and more important, the idea of mutual respect.

The federal budget has huge challenges for Indian Country, including the prospect of a shutdown this fall. The coming fight over the debt limit is an example of the complexity ahead.

President Donald J. Trump announced the United States was pulling out the Paris agreement on climate change. Four Native Nations, however, said they will continue to support the Paris agreement because climate change touches all aspect of life.

This is what the Trump Reality Show hides: The House’s Health Care plan does much more than roll back the Affordable Care Act (or Obamacare as they like to say.) It ends Medicaid, the single most effective form of “government” insurance that secures health care options for 62.3 million Americans. To add perspective: Medicare — supposedly untouchable in politics — insures 43.3 million seniors. Medicaid is adding money to the Indian health system.

The House of Representatives passed the American Health Care Act by four votes last week. The legislation now moves to the United States Senate for consideration. This bill would dramatically reshape the healthcare system, including Indian health because it would end Medicaid as we know it. Medicaid insures more than half of all children in the Indian Health system and it accounts for 13 percent of the Indian Health Service budget.

Special elections set the tone for the 2018 congressional races. And Indian Country’s first chance to judge the Trump administration comes in Montana on May 25.