This week Governor Mike Pence, a Republican (some say dark-horse GOP presidential candidate) and staunch opponent to the Affordable Care Act, announced an agreement with the Obama administration to expand Indiana’s Medicaid program. This makes 28 states so far that have voluntarily opted to expand coverage to low-income uninsured Americans and could potentially benefit 375,000 Hoosiers.
This is a triumph for the precarious in my home state, though to be clear it is a mitigated victory. The expansion is complicated by traditional Medicaid standards, but briefly nearly every component I described last year as a part of the ‘HIP 2.0’ proposal was accepted by HHS. There will be two tiers, separated by the federal poverty line, with everyone below 100 percent having access to ‘basic’ coverage. This will unfortunately include some co-payments, but cannot be revoked and will provide every essential benefit required by the ACA. For an additional contribution to a health savings account beneficiaries can also have access to vision, dental, and prescription drug coverage. Those with annual incomes between 100-138 percent of FPL will have access to all of those services but will be required to contribute to their HSA or else be locked-out of coverage for six months. This last particular feature is a first for CMS to allow, and the available evidence indicates that requiring contributions mostly results in people avoiding care altogether.
Despite all this, predictably, the political right is still upset over such a momentous defeat. While Pence is doing everything under the sun to describe this expansion as a conservative accomplishment worth celebrating, none are buying it. The poor will be helped but not punished too much in the process, as it ultimately excluded the desired requirement for work (and presumably drug tests). Most importantly, it seems, the deal lays bare the absurdity of pretending a “market-based” American health care system would somehow not involve big business and the state working together.
That’s all I can muster to write on their specific objections, honestly. Those are all their own issues to reconcile, not mine, and I have only so many crocodile tears for their loss. That’s because they would have been cool with the actual counter-factual, which isn’t a compromise that allowed even more punitive skin-in-the-game, but the absence of any compromise, period. Indiana’s plan is no-one’s notion of a policy utopia. Yet the alternative was to continue the inhumane status-quo, like Florida and Texas, who are still the pack leaders in the race to be as morally defunct and obtusely cruel to their most vulnerable citizens as possible.
In that sense there is a fundamental difference between those who are outraged over this and myself. I’ll take the imperfect solution over nothing at all. And at the end of the day, so was Mike Pence. So for that, governor, I really do thank you. I know folks that will have health insurance coverage for the first time in their adult lives starting next week. That was worth fighting for, and is worth celebrating as a genuine victory.