Indiana politicians still grappling over Medicaid expansion
BY CHRISTIN NANCE LAZERUS email@example.com January 21, 2014 9:58AM
Gov. Mike Pence criticized Medicaid in his State of the State address last week, but some say the state is leaving too many Hoosiers out in the cold by not taking the federal government up on its offer to fund an expansion of the program. | AP Photo
Updated: February 24, 2014 6:29AM
In his State of the State address last week, Gov. Mike Pence reaffirmed his opposition to expanding traditional Medicaid in Indiana.
But Democratic lawmakers and health experts say denying coverage to an estimated 400,000 Indiana adults is a bad idea.
Pence said he is in talks with the federal government about expanding coverage for lower-income Hoosiers through the Healthy Indiana Plan, which currently covers about 40,000 adults, but federal officials don’t like the HIP requirement that participants pay into a Health Savings Account. Healthy Indiana also doesn’t have maternity coverage and other benefits required by Medicaid and the Affordable Care Act.
One of Pence’s statements, critics say, wasn’t particularly germane to the debate.
“Research shows that the program does not lead to better health outcomes and in some cases hurts the very people it is supposed to help,” Pence said. “One analysis found two-thirds of the children on Medicaid who needed to see a specialist couldn’t.”
Pence was referring a June 2011 study in which research assistants, posing as mothers of children who require specialty care, tried to make appointments with doctors in Cook County, Ill.
“If he was arguing that you can get an appointment faster with private insurance, that may have been what the researchers found, but that’s not informing the choice before us right now,” said Dr. Aaron Carroll, director of the Center for Health Policy and Professionalism Research at Indiana University School of Medicine.
“If we were debating whether we should have Medicaid or private insurance, I could entertain the argument. But it’s hard to make the argument that having nothing would be preferable to having Medicaid.”
Republicans have argued that Medicaid expansion is too expensive — estimated at $503 million through 2020 — but with the federal government covering 100 percent of the expansion costs through 2016 (that pecentage goes down to 90 percent by 2020), Carroll said it’s worth it in the long run.
“It’s so small compared to what the federal government will be paying,” Carroll said. If Indiana doesn’t take advantage of the offer, “the state is seeing a loss of federal taxes.”
He said it would cost less to expand traditional Medicaid compared to expanding Healthy Indiana.
Carroll co-wrote an article in the New England Journal of Medicine in 2011 that was critical of those who take some studies and argue that Medicaid causes bad health outcomes.
“It’s taking an association and making a causation,” Carroll said. “Some of these studies are not properly done. People on Medicaid are more likely poor, the poor tend to have worse health, and without controlling for that variable, you could easily do a study to prove Medicaid patients are in poorer health. But people can also qualify for Medicaid if they are disabled.”
By refusing to expand Medicaid, the state is giving up an estimated 25-percent increase — about $17.3 billion — in federal funds through 2022, according to the Kaiser Family Foundation.
Sen. Karen Tallian, D-Ogden Dunes, said it seems to be hard for Pence to let go of his knee-jerk opposition to the ACA.
“This governor was in Congress representing one district while he was in Washington, D.C., and he fought the passage of the ACA,” Tallian said. “Now, he’s back in Indiana and governor of everybody, and he needs to get off this soapbox and just say yes.”
Tallian agrees that there are problems with Medicaid, particularly the low doctor reimbursement level that leads many doctors to not accept Medicaid insurance.
“But to just say it’s broken and therefore do nothing and just go to the ER? That’s just not an option,” Tallian said.
Tallian has introduced two bills: a “Just say yes” bill and an alternative expansion based on the model approved for Arkansas.
“I believe it would appeal to Republicans,” Tallian said. “It uses the federal dollars to buy a policy on the exchanges from a private health insurer; that’s about as free market as you can get.”
If they are headed that route, Tallian said it would also make sense for the state to set up its own exchange.
“It would offer us big flexibility in programs and policies,” Tallian said. “We’re a very insurance-friendly state.”
Tallian’s bill is assigned to the Appropriations Committee this year, and she hopes Chairman Sen. Luke Kenley, R-Noblesville, gives it a hearing.
Indiana Hospital Association Vice President Brian Tabor said different states are rolling out the Medicaid expansion in unique ways.
“It gives us the opportunity to look and pull ideas from those states,” Tabor said. “Our ultimate hope is from pulling the best parts, we can get thousands of Hoosiers covered.”