INDIANAPOLIS | In a Statehouse filled with Republicans diligently working to undermine implementation of the Affordable Care Act, state Rep. Ed Clere, R-New Albany, is instead seeking a path under the federal law that ensures low-income Hoosiers gain access to low-cost health care.
"We all have an interest in finding responsible, innovative, creative ways to cover these uninsured Hoosiers, and I have to believe the federal government and the state government can come together within that broad goal and find a way to make it work," Clere said.
The chairman of the House Public Health Committee, Clere rewrote Senate Bill 551 last week to remove a Senate-approved mandate that any negotiations between Indiana and the federal government over expanding Medicaid eligibility be conditioned on the federal government's giving the state all the money it spends on Indiana Medicaid -- an extremely unlikely prospect.
Clere's decision to replace that provision with a requirement the governor negotiate a reasonable Medicaid expansion, possibly following the contours of the Healthy Indiana Plan, set off Senate President David Long, R-Fort Wayne, and Republican Gov. Mike Pence who claim they want a similar policy, but whose actions suggest they do not.
"That did surprise us a little bit. I know it surprised the governor," said Long, who has called for a federal constitutional convention to strike down the health law he calls Obamacare. "It isn't that we don't support the potential expansion of Medicaid here, but it has to be a state-driven plan."
Pence, who initially likened the U.S. Supreme Court decision upholding the constitutionality of Obamacare to the Sept. 11, 2001, terrorist attacks, said simply, "I support the Senate bill."
Under the Affordable Care Act, approximately 400,000 Hoosiers will become eligible for Medicaid next year if Indiana simply accepts federal funding that covers 100 percent of the cost for the new Medicaid enrollees.
Pence repeatedly has said he will not do it, which will make those Hoosiers not only unable to access Medicaid, but also ineligible for federal tax credits to buy private health insurance.
That means the state must seriously negotiate with the federal government over what health care for low-income Indiana residents will look like, Clere said, who also opposes expanding traditional Medicaid.
The Senate proposal did not do that, he said.
"There are still a lot of unanswered questions and we face the certainty that at the end of the session there will be no certainty," Clere said. "So this (House) bill attempts to give the administration maximum flexibility to negotiate once the Legislature is no longer in session, but it does require the administration to at least try to strike a deal."
Clere said he's open to using the high-deductible Healthy Indiana Plan as the expansion vehicle and is also interested in the so-called Arkansas model, where the state buys private health insurance on behalf of its needy citizens.
"I have to believe that everyone in this building, including Gov. Pence, would like to find a way to give hard-working Hoosiers access to affordable health care," Clere said. "There's certainly no harm in advancing a bill that requires the administration to at least make a good-faith effort at taking advantage of that opportunity."
Pence said Thursday he's talked with federal health officials about alternatives to traditional Medicaid expansion in Indiana, but said even if he gets permission to chart a new course he isn't promising he will.
"Any decision to do so will be predicated on whether or not we can innovate with consumer-driven health care and whether or not it's fiscally responsible," Pence said.