Editor's note: This story is part of an occasional series that looks at how the Affordable Care Act affects the region.
Federal approval last week that granting a one-year extension to a government-supported health insurance program in Indiana has some people wondering what will happen to Hoosiers left uninsured.
The Healthy Indiana Plan, known as HIP, began enrolling beneficiaries Jan. 1, 2008.
"Indiana was creating a model that was very progressive," said Samuel Flint, associate director of Indiana University Northwest's School of Public and Environmental Affairs, who backed the idea at its inception. "Indiana was in the forefront of trying to solve the problem of the uninsured."
The idea was to use unused funds from the Children's Health Insurance Program, called CHIP, to enroll parents of mature children.
"It was a good plan at the time, but now you don't have to do that," Flint said. "You can have full Medicaid coverage."
The Affordable Care Act allows states to expand Medicaid eligibility to Americans earning up to 133 percent of the federal poverty level. The federal government will pay 100 percent of the cost of new enrollees the first three years, then gradually decline to 90 percent by 2020.
"It's the most generous federal share in history," Flint said. "Nobody expected that the states would turn down free money."
Indiana did. Illinois didn't.
Gov. Pat Quinn signed a law in July to expand Medicaid in Illinois, with an estimated 342,000 low-income Illinois residents now eligible for government-sponsored health insurance through Medicaid.
Money taxed from Hoosiers will be used to help pay for states with expanded health care.
"The red states are taxing the people, and their money is going to the blue states," Flint said.
If people pressure legislators, the decision can be reversed in the future, Flint said. "(The year) 2014 is locked in," he said. "But the door is wide open to change it for 2015 and going forward."
U.S. Sen. Dan Coats, R-Ind., was pleased Indiana received a one-year extension on HIP.
"The concept of the plan I think is much more affordable, much more effective than what the Obamacare plan is turning out to be," he said. "And so we can be a model here in Indiana for perhaps the country, in terms of something that works."
The decision not to expand Medicaid affects more than just the people left uncovered.
"It's the non-Medicaid population that's going to be paying the bills for people that could be paid for under federal dollars under Medicaid," Flint said.
Indiana Gov. Mike Pence announced last week that HIP received a one-year extension from the federal Centers for Medicare and Medicaid Services. But about 11,000 low-income Hoosiers enrolled in HIP will be forced out, because participants cannot exceed the federal poverty level.
They will be encouraged to buy insurance through the health insurance exchange.
Indiana has about 880,000 uninsured residents, 500,000 of whom are expected to buy federally subsidized health insurance, leaving 330,000 residents uninsured.
Pence suggested uninsured Hoosiers use emergency rooms, free clinics and charity care for their health needs.
Beth Wrobel, CEO of the federally qualified health center HealthLinc, said such local centers work hard to keep people out of emergency rooms by getting them preventive and primary care.
"You're not going to get preventive care in an ER," she said.
The goal is to improve the health of Hoosiers who lack access to care.
"I can do a lot inside my four walls, but if someone needs something extra (special tests or special medication), I can't do that," she said. "I can't get that without insurance."