POPLAR — Margaret Abbott, a 73-year-old professor at Fort Peck Community College, has a simple reason for why president-elect Donald J. Trump didn’t offend Native Americans like he did other minority groups during his campaign.

“He can’t send us anyplace,” she said. “He can’t send us back where we came from, because we’re already there.”

Trump’s fraught relationships with minorities came out in a series of flashpoints during the campaign. Key staff appointments Trump made since his election have done little to calm fears.

As a candidate, Trump almost entirely overlooked Native Americans, which make up 1.7 percent of the total U.S. population and 6.32 percent of Montanans. But Trump has clashed with American Indian groups in the past. The Washington Post reported earlier this year that in the 1990s Trump claimed Indian reservations were controlled by the mafia and said in a radio interview that many who claim to be Indians aren’t.

Trump did not meet with tribal representatives in Billings before his May rally there. Both Democratic primary candidate Bernie Sanders and former President Bill Clinton, who visited Montana on behalf of his wife, met with tribal leadership before their May events in Montana’s largest city.

Many who live on Montana's seven reservations are unsure of what to expect.

Mark Azure, president of the Fort Belknap Indian Community in north-central Montana, sent a letter to his community after the election saying, in part, "what exactly this means to Indian Country is uncertain at this time."

Deanna Bigby, 32, is a student at Aaniiih Nakoda College on the Fort Belknap Reservation, where she lives. She is worried about what Trump's campaign pledge to repeal and replace the Affordable Care Act.

Once elected, Trump backed off from a full repeal, saying he would keep parts of the law, though it’s unclear what he will do once he takes office in January.

“A lot of people here depend on the government for health care,” Bigby said.

Her friend, Monique Doney, a 21-year-old student here, agreed. “He could take a lot away from people who need free health care,” Doney added. Both she and Bigby hope to be nurses one day.

Trump has not mentioned Indian Health Service, though Rep. Tom Cole, R-Oklahoma, one of his advisers on American Indian issues, said any changes to the law must keep in place funding for health care for American Indians.

Jace Killsback, the newly elected chairman of the Northern Cheyenne and tribal health director, said his main concern is the permanent re-authorization of the Indian Health Care Improvement Act, which President Barack Obama included in the Affordable Care Act.

“That gave tribes new avenues to provide better access and better services for their tribal members. Nursing homes, dialysis centers, traditional medicine, all those kinds of things we’ve been asking for,” he said.

The law also has provisions that waive any cost-sharing, co-pays or deductibles for federally recognized American Indians who enroll in the marketplace and allows for enrollment at any time.

“We were able to see a lot of tribal members sign up who otherwise didn’t have health care because of the subsidy that was offered in the marketplace,” he added.

The concept of insurance was fairly new in Indian Country, Killsback said. Before tribal members relied on Indian Health Service, which is not insurance but care available at clinics and hospitals.

Insurance coverage for tribal members lessens the financial burden on IHS, which is historically underfunded. IHS often treats patients only on a “life-or-limb” basis, meaning if a person isn’t about to lose a limb or die, they don't get care. 

Tribes are entitled to health care as a treaty right, Killsback said.

“Our ancestors gave up millions and millions of acres of land in return for goods and services,” he said. “This is something we hold dearly because of the bloodshed our ancestors gave for this.”

Mark Trahant, a professor at the University of North Dakota who writes about public policy from an American Indian perspective, said environmental issues will be potential challenging to tribes under a Trump administration.

“Where that really impacts the Native community is in litigation,” he said. Some tribal communities in Alaska, he said, will need to be relocated in the next four years because of rising sea levels.

In Big Horn County, which contains a large part of the Crow Reservation, Trump fared far better than he did on Montana's other reservations. There he received 42 percent of the vote to Clinton's 48, getting just 241 fewer votes. Trump received 31 percent of the vote in Glacier County, home to the Blackfeet Reservation.

The Crow Reservation is home to the Absaloka Mine, operated by Westmoreland Coal Co. The tribe also has a stalled deal with Cloud Peak Energy to open another mine. But Trump’s promises to open up coal mining aren’t necessarily a rubber stamp on this project.

“Both he and (Rep. Ryan) Zinke have made a big pitch about the resurgence of coal,” Trahant said. “It’s a promise I’m not sure they are going to be able to keep. Coal has been impacted by market forces more than anything else.”

One potential good outcome that could come from Trump’s administration, Trahant said, is if he keeps his promises on infrastructure spending.

Trump's transition website says his administration will "invest $550 billion" in roads, bridges, airports, transit systems and ports and mentions "poorly maintained farm/ranch-to-market roads." Two of Trump's senior financial advisers in an October paper presented a plan to provide private investors with an 82 percent tax credit on projects, though opinions on whether the plan is feasible are divided.

“If in fact he does infrastructure spending, almost every reservation could use that,” Trahant said. “If there’s any kind of equitable way of doing it and it creates jobs, that’s a good thing.”

What comes next could be a way to build both real and metaphorical bridges, said Trahant, whose grandmother lived in Frazer, about 40 miles west of Poplar.

“This could be an opportunity for rural communities to try to figure out how to work together,” Trahant said. “In the end communities across the Hi-Line have so much more in common than apart. The same challenges in Frazer are facing rural communities across the United States.”

He worries, though, where money to pay for those credits could come from and what could be cut from the nation’s budget.

“So much of federal programs on the reservation are really lifelines, and there’s really no replacement from a private sector. There isn’t a private sector to depend on.”

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Reporter covering statewide issues for The Billings Gazette.