Since the beginning of last year there’s been a successive wave of states moving forward on expanding Medicaid under the Affordable Care Act. Indiana, led by the fairly conservative Republican Governor Mike Pence who opposes the ACA, has thus far refused to expand the joint federal-state insurance program that provides comprehensive coverage for low-income Americans.
Yet it hasn’t been an entirely silent refusal. In 2013 Indiana requested, and ultimately received, an extension of a pilot program (HIP) that provides health insurance coverage through high-deductible plans paired with health savings accounts to almost 40,000 low-income Hoosiers. As a part of that request the state also inquired about expanding HIP using Medicaid expansion funding provided by the 2010 health care law.
To my knowledge there’s been no official response on that question, but last November Governor Pence quietly requested a meeting with Health and Human Services Secretary Kathleen Sebelius to further discuss the possibility. On Friday that meeting happened.
According to the news release from the Governor’s office:
The meeting resulted from a letter Governor Pence sent to Secretary Sebelius on November 15, 2013 requesting a meeting to discuss the state’s pending waiver to use the Healthy Indiana Plan as an alternative to the traditional Medicaid model for the expansion. In the letter, Pence cited the program’s high customer satisfaction rates, positive outcomes, and lower healthcare costs over time.
In the meeting, Governor Pence affirmed the state’s commitment to addressing Secretary Sebelius’s concerns about required cost-sharing below 100 percent of the Federal Poverty Level while still maintaining the Healthy Indiana Plan’s foundational principles of consumerism and personal responsibility.
Excluded is any sort of indication whether the meeting produced any meaningful movement. It’s probably good news that the state acknowledges, at the very least, why an expansion of HIP in it’s current form isn’t on the table. Beyond the cost-sharing aspect, which isn’t allowed in traditional Medicaid, there’s also the state-mandated annual limit and lifetime caps for program enrollees — two things that have been explicitly banned under the ACA. So while the ongoing talks are encouraging, it’s difficult to imagine the Obama administration agreeing to a compromise that significantly featured those three components. Unfortunately, those also appear to be the Governor’s favorite parts.
In the meantime there’s still an estimated 181,930 Hoosiers in the ‘coverage gap,’ which is a category for those too wealthy to qualify for eligibility in the traditional Medicaid program but too poor to qualify for assistance in purchasing private insurance on the exchanges established by the ACA. Nearly three-quarters of that group are adults with dependent children, and over half of which live in a working family. Relief for those folks might have to wait until 2015, or until Pence decides on how much “personal responsibility” low-income Hoosiers should have before gaining access to the health care system.