We are witnessing perhaps the most vivid contrast between gubernatorial candidates Mike Pence and John Gregg coming with the politically explosive issue of Obamacare.
Knowing he would not have to live with decisions made by November deadlines on establishing Essential Health Benefits and the Health Exchange the law calls for, Gov. Mitch Daniels asked for input from the candidates, saying he will follow the advice of the winner on Nov. 6.
The backdrop to this is that Obamacare is extremely unpopular in Indiana. A December 2011 Public Opinion Strategies Poll revealed that 57 percent oppose the law and only 35 percent support it. On a repeal question, 55 percent support and 35 percent are against.
Democrat Gregg acknowledged that dynamic when he said, "I want to make this clear, it does not matter whether you support the Affordable Care Act or not, whether you love it or hate it, it is the law of the land. My job as governor will be to protect the best interests of the people of this state and enforce the law in a way that will benefit all Hoosiers and make health care more affordable and more accessible for all Hoosiers."
He then laid out a position diametrically opposed to Republican nominee Pence. In doing so, we find the Democrat taking a pragmatic approach to the law, while Pence has adopted an ideological stance that will likely be more politically popular.
After meeting with Daniels, Pence explained, “First, the national debate over the Affordable Care Act is far from over."
Pence is a vociferous opponent of Obamacare, voting against it in March 2010 and on 33 other House votes to repeal. "While the Obama administration, its allies in Congress and the Supreme Court have had their say on this health care law, the American people will have their say in November,” he said. “With such political uncertainty surrounding the Affordable Care Act, it would not be prudent for the state to require Hoosiers to spend their time and hard-earned money on the implementation of a federal health care law that may be overturned in the next Congress."
Pence equated the initiation of the health exchanges to a tax increase, an area on which he has based much of his campaign. "With our unemployment rate at 8.2 percent and too many Hoosiers out of work, I will not support the implementation of an Indiana exchange when there is a chance that doing so would lead to a tax increase on Hoosier employers,” he said.
Pence made these other other points: There is too much “regulatory uncertainty” surrounding the operation of exchanges; the federal government is still delinquent on complete guidance for exchanges; there is “fiscal uncertainty,” saying the cost to Hoosier taxpayers for setting up our own exchange could be at least $50 million per year and perhaps higher; and there is “legal uncertainty” as to whether the state-operated exchanges can mandate penalties on employers.
Gregg cited two points: "First, the federal government is very prescriptive as it relates to EHB plans and in order to assist states in the selection of minimum benefits for plans in the exchange, the federal government has named four options, all of which must cover services in 10 different areas. I fully support the Healthy Indiana Plan benefit levels. However, the federal government requires maternity benefits and HIP does not pay for those services at this time. Accordingly, I support using Indiana's Healthy Indiana Plan as the basis for our EHB plan, with additional coverage as required by the federal government.
"Second, the federal government has offered several options to states in moving forward on an exchange. States may choose a state-designed and controlled exchange, and they can choose a hybrid system that allows for a partnership with the federal government but still allows for state control; or they can choose a regional partnership with other states.”
Gregg said he is leaning toward a hybrid system.
Gregg added, "Our belief is that the most responsible position for the governor to take is the one that Gov. Daniels has been pursuing all along – to meet deadlines and apply for grant monies available to keep all options open to us.” He said Daniels’ actions have brought $8 million to the state.
And for the first time in this campaign, Gregg and Pence exchanged shots. Gregg chided his opponent, saying, "Unfortunately, Congressman Pence has chosen to do nothing. In doing so, he makes the choice to abdicate his responsibility and throw Hoosiers under the federal bureaucracy bus, the same bureaucratic bus that he claims he so adamantly opposes."
Pence retorted, saying, "Hoosiers don't want their hard-earned money spent implementing the Obama Administration's deeply flawed health care bureaucracy. Hoosiers now have a clear choice in this election. I choose more freedom, more innovation and Hoosier solutions over Obamacare."
A critical question, then, is whether Obamacare will be repealed. That would take a Mitt Romney win, along with a Republican Senate majority, as well as some vigorous legislative maneuvering unless the GOP wins 60 seats.
The GOP Senate majority – once seen as likely – is in grave doubt as a number of Republican Tea Party candidates such as Missouri’s Todd Akin have floundered, just like they did in 2010.
Brian Howey is publisher of Howey Politics Indiana. Follow him on Twitter @hwypol. The opinion expressed in this column is the writer's.