Between 240 and 758 Hoosiers could die annually because Indiana has not opted to expand Medicaid, according to researchers at Harvard Medical School and City University of New York.
The annual death toll from 25 states that have not yet opted into Medicaid expansion, which is provided through the Affordable Care Act, could number in the thousands, according to the researchers.
Published in the journal Health Affairs, the study shows an estimated 7,115 to 17,104 more deaths will result nationally, and many more people will have their health suffer because of skipping mammograms and pap smears and for leaving other conditions, such as depression and diabetes, untreated.
"How many poor people without health insurance can get a mammogram?" asked Dr. Alex Stemer, president of Franciscan Medical Specialists. "If you don't have health insurance are you going to get a mammogram? No."
The same goes for preventable diseases that could lead to death, such as the flu and pneumonia.
"How many will get the flu and die because they can't pay the $30 or $40?" Stemer asked.
Pap smears check for HPV, which can lead to cervical cancer.
"How many women – particularly poor – have been exposed and don't get pap smears?" he asked.
People left with untreated diabetes or high blood pressure could end up with more serious health issues, such as kidney failure. They will get sick and end up in an emergency room, and people with private insurance will bear the cost, Stemer said.
"You and I are going to pay for it, one way or another," he said. "Would you rather pay for the prevention or the treatment?"
Stemer, who does not like much of the Affordable Care Act, said the Medicaid expansion is one of the good parts of the law.
"My hope is that our governor and legislators reconsider their position," he said. "I think it unfairly and uniquely disadvantages one part of our population."
The Affordable Care Act, also known as Obamacare, 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.
Medicaid expansion opponents say the declining federal share leaves states on the hook eventually for an increased portion of the bill.
Indiana has not chosen to expand Medicaid, a decision it could change. Rather, it received an extension for its Healthy Indiana Plan. The state calls HIP "a consumer-directed alternative to Medicaid that has shifted the Medicaid paradigm in Indiana."
"Indiana has submitted a waiver to bring health care coverage to more Hoosiers through an expansion of the Healthy Indiana Plan," said Kara Brooks, press secretary for Gov. Mike Pence.
A report released recently through the National Women's Law Center highlights disparities between low-income women with and without health insurance. It shows about 135,000 Hoosier women are left in a coverage gap, with incomes below the poverty level but not eligible for the state’s current Medicaid program.
Not everyone supports Indiana's refusal to expand Medicaid.
A local One Region health initiative called the Northwest Indiana Health Advisory Council, which comprises local health advocates, last month sent a letter to Pence, imploring him to expand Medicaid in the state.
Expansion would increase health care benefits to all Hoosiers and keep tax dollars in Indiana, they argued.
Initiative co-chair Pat Bankston, associate dean at Indiana University School of Medicine Northwest and dean of the College of Health and Human Services at Indiana University Northwest in Gary, said there are parts of the Affordable Care Act that he is not so happy about, but Medicaid expansion is not one of them.
"I think it's the right thing to do," he said.