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Lawmakers continue to weigh health care

Pence

Pence

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Updated: May 9, 2013 6:21AM



There’s a larger window for potential health care coverage expansion after the legislation was amended April 1, but Gov. Mike Pence preferred the old approach.

Senate Bill 551 is this session’s last chance to make sure that an estimated 400,000 people in Indiana are not left uninsured. The bill as passed out of the Senate would use block grants to expand the current Healthy Indiana Plan (HIP). Most importantly to Senate leaders and Pence, the health care expansion should include features like fiscal responsibility and the ability to ask those to contribute to their care.

State Democrats worry that the Centers for Medicare and Medicaid Services (CMS) may not approve of the plan, leaving those who make less than 138 percent of the poverty level, but more than 24 percent stuck with paying for their own health insurance.

A number of changes to Senate Bill 551 were set by the House Public Health Committee. The chairman, Rep. Ed Clere of New Albany, said the changes were designed to provide the Pence Administration options.

“Basically what we were trying to do is allow greater flexibility,” Clere said. “Not just to expand HIP but to look at other market based considerations that might work for Indiana.”

It now requires that the state negotiate with the federal administration to find a suitable plan instead of Medicaid to cover those who would qualify. The main requirement during the talks is a provision that allows Indiana to stop the health care program if the federal government passes too much of the costs onto the state.

The Affordable Care Act, known as Obamacare, offers to pay for all of the costs of expansion for the first three years, then phase down each year until 2020 when the federal government will continue to cover 90 percent of the cost.

“If Congress says in 2020 they are going to drop their contribution to 85 percent, Indiana would terminate their program,” he said.

The language doesn’t require the state to take any offer, Clere added. Just make a good faith effort, and report back to the state if no deal can be found.

Whether that plan be similar to Indiana’s HIP system, or a program proposed by Arkansas, where federal dollars would be used to put those on private health insurance programs.
It also removes the language to the bill that mentions using block grants.

“There’s concern that the term block grant is politically charged term. It has a lot of partisan debate,” Clere said. “Even though it’s a debate I’d like to have, I’m not sure it’s the right time.”

But the changes are stirring up concerns with Republican leaders. Pence said Thursday that he supports the original Senate bill language and that his administration is in discussion with CMS to renew the Healthy Indiana Plan, and if it’s renewed, use it as a format to expand coverage.

“My criteria is we can continue to innovate, and affordability,” Pence said, “I’ve said that consistently.”

Rep. Tim Brown, who heads the Ways and Means committee, said Thursday he was surprised at the changes made to the bill. The bill heads to his committee next week.

Clere agrees with Republican leaders that traditional Medicaid doesn’t’ work. He wasn’t willing to speculate on what could happen to the bill next, but it’s more important to him that the state considers some action.

“All I’ve wanted to do is elevate the issue for discussion,” he said, “and make sure we’re talking about it and moving toward action. I don’t know how it will look in the end, but I think that move towards action is what’s going on.”



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