INDIANAPOLIS | Indiana lawmakers and the state's next governor will decide next year whether up to 500,000 more low-income Hoosiers will receive Medicaid health coverage starting in 2014.
The U.S. Supreme Court ruled Thursday that states can't be punished if they ignore a requirement of the Affordable Care Act and refuse to increase their Medicaid eligibility income limit to 133 percent of the federal poverty level. That's about $15,000 a year for an individual or $30,000 for a family of four.
The higher limits will make nearly 1 in 4 Hoosiers eligible for Medicaid.
A 2010 analysis presented to the General Assembly estimated the state's cost to add a half million Hoosiers to the Medicaid rolls at $2.5 billion to $3.1 billion between 2014 and 2020, even with the federal government covering the entire cost of new enrollees the first three years.
State Sen. Brandt Hershman, R-Wheatfield, chairman of the Senate Tax and Fiscal Policy Committee, said Medicaid already makes up 10 percent of Indiana's budget and any increase likely would require pulling money from education, or a tax hike.
"I think we would be very cautious before we would accept any further expansion of Medicaid," Hershman said. "Although there is some additional federal funding available, there is a significant state responsibility as well."
Senate President David Long, R-Fort Wayne, said Indiana will "certainly" opt out of "Obamacare's Medicaid mandate" and avoid a "tax increase waiting to happen."
But state Rep. Charlie Brown, D-Gary, the top Democrat on the House Public Health Committee, said the Republican-controlled General Assembly shouldn't ignore the health needs of Hoosiers just to stick it to the Democratic president.
"We have to remove the politics from it and look at what's good for Indiana," Brown said. "My philosophy is health is a right, not a privilege."
Brown said the federal government should permit the state to use the existing Healthy Indiana Plan, a low-premium, high-deductible insurance program for low-income Hoosiers, as the model to extend coverage to newly eligible Medicaid recipients.
Republican Gov. Mitch Daniels, whose final term ends in January, said he also hopes HIP will continue.
"We wish we could persuade them to let us let Medicaid look like HIP, as opposed to, in essence, destroying HIP," Daniels said.
U.S. Rep. Mike Pence, the Republican candidate for governor, said the Supreme Court ruling "erodes the freedom of every American" and called for an immediate repeal of the entire health law.
He said any increase in Medicaid eligibility "would expand an already broken and unaffordable system," but said a final decision can't be made until the federal government decides whether HIP can exist.
Daniel Altman, spokesman for Democratic gubernatorial candidate John Gregg, said the former Indiana House speaker was still reviewing the court's ruling, but "as governor, John will bring Indiana patients, physicians, stakeholders and insurance companies together to discuss how to implement this law in the most cost-effective and consumer-friendly way."