News From Terre Haute, Indiana


May 17, 2014

EDITORIAL: Governor, staff deserve credit for negotiating to expand health care

TERRE HAUTE — The bottom line matters most with a long-overdue health-care proposal announced Thursday by Indiana Gov. Mike Pence.

His staff labels it “HIP 2.0,” a significant enhancement of the state’s existing Healthy Indiana Plan. Pence describes it as “consumer-driven health care.” President Obama’s administration called the governor’s idea a “Medicaid coverage expansion,” as prescribed in the Affordable Care Act. The president’s critics derisively brand the ACA “Obamacare.” A critic of Pence’s plan, writing for Forbes, warns that HIP 2.0 will become “a Medicaid expansion with some free-market window dressing.”

The name worn by the Indiana plan — be it HIP 2.0, Healthy Indiana Part Deux, or Pencecare — is of little consequence. The results are what matters. If the federal government views Pence’s Healthy Indiana Plan expansion as an acceptable version of Medicaid expansion, then 350,000 currently uninsured, low-income, non-disabled Hoosiers ages 19 to 64 will become eligible for health-care coverage.

That expansion is a big deal for Indiana. The state persistently ranks near the bottom nationally in the health of its residents, with high rates of smoking, heart disease, obesity and cancer. That dismal situation weakens the Hoosier workforce and diminishes economic productivity. The lack of attention to health — including regular, preventative care — costs Indiana greatly right now. Pence has taken a big step toward improving that bleak predicament.

Twenty-three states and the District of Columbia had already taken that step through expanding Medicaid as outlined in the Affordable Care Act. A Supreme Court ruling made that expansion optional. Thus, nearly two dozen states — most led by Republican governors who oppose the president and his health-care plan — have refused to implement the Medicaid expansion, which extends coverage to people with household incomes at 138 percent of the federal poverty level (or about $33,000 for a family of four). It is a legion of Americans who earn too much to qualify for Medicaid and don’t qualify for a subsidy through the ACA.

Three states — Arkansas, Michigan and Iowa — crafted their own state-specific plans, approved by the federal government. Three others are pursuing their own options, too. The HIP 2.0 proposal by Indiana is similar, yet different because of the component Pence terms “consumer-driven.” Recipients with incomes within the “coverage gap” — those with earnings at 100 to 138 percent of the poverty rate — would be asked to contribute from $3 to $25 monthly to their health savings (or POWER) accounts. It also includes high deductibles, which patients could pay with savings account funds.

The idea will go to the U.S. Centers for Medicare and Medicaid Services, which could approve it or ask for revisions. The state will take public comments for a month and conduct two public hearings in Indianapolis.

In his announcement, Pence repeatedly affirmed his long, unwavering distaste for the president’s health-care overhaul, invoked former President Reagan’s memory and labeled Medicaid “a fiscal monstrosity.” Given his consideration of a run for the 2016 Republican presidential nomination, Pence’s conservative spin on the proposal is unsurprising and a political necessity. Still, his expansion plan is occurring because of the ACA and would be fueled by Indiana’s access to Medicaid expansion funds, regardless of the adjectives or names used to identify it.

“It’s just how one wants to pitch it,” Kosali Simon, professor of health economics at the Indiana University School of Public and Environmental Affairs, told the Tribune-Star on Friday.

The bottom line is, the governor and his staff deserve credit for working with the Obama administration’s Health and Human Services team and the Centers for Medicare and Medicaid Services to reach this point. Let’s call it an innovative compromise.

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