After listening to Gov. Mike Pence and legislative leaders at the calendar halfway point of the Indiana General Assembly, one thing is clear: We have a lot of ideology and lack a lot of metrics and answers.
I’ll give you the prime example: Pence and Republicans such as Senate President Pro Tem David Long and Speaker Brian Bosma are opting for the Healthy Indiana Plan as opposed to the expansion of Medicaid under the Affordable Care Act (otherwise known as “Obamacare”).
While these Republicans are quick to say Medicaid expansion will almost assuredly be too expensive, no one can say what HIP will cost.
In the past two weeks, a parade of conservative, Republican governors – all greatly hostile to Obamacare – have made the controversial call to expand Medicaid during a three-year period when the federal government will pick up 100 percent of the costs. Ohio’s John Kasich, Michigan’s Rick Snyder, Florida’s Rick Scott and New Jersey Gov. Chris Christie, himself a potential presidential rival of Pence, have begrudgingly opted for Medicaid expansion.
As Christie put it, “Let me be clear: I am no fan of the Affordable Care Act. I think it is wrong for New Jersey and for America. I fought against it and believe, in the long run, it will not achieve what it promises. However, it is now the law of the land. I will make all my judgments as governor based on what is best for New Jerseyans.”
Michigan's Snyder said on Feb. 6, “This makes sense for the physical and fiscal health of Michigan.”
Pence, however, described it in political terms, saying Medicaid expansion is “where the government says, ‘Here’s a baby elephant. We’ll agree to pay for the hay for the next five years.’” Pence added, “Washington is broke, with more than $16 trillion in national debt.”
Long, Indiana's Senate president pro tem, noted that state Sen. Pat Miller’s bill to expand the Healthy Indiana Plan passed the Senate, but quickly acknowledged that no one knows what the cost of HIP will be, even while denouncing Medicaid expansion in general. “I’ve never heard an answer if we just did the HIP plan,” Long said. “Can we afford that?”
But key Republicans view opting into the Medicaid expansion with the feds picking up 100 percent of the costs through 2020 as a slippery slope or Hotel California: Once in, “you can never leave,” as the Eagles might croon.
Another way to look at it is opting in gives Indiana three years to seek alternatives, and at no cost. Adding to this dilemma is the slow pace of new rules coming to the states from the federal government.
“What happens in three years?” Long queried when asked why Indiana wouldn’t opt in for the three years when the federal government picks up 100 percent of the cost. “You continue to see reports of the costs of this program going way above what they were. How are you going to pay for that?”
I asked Long about the scenario Republican House Public Health Chairman Ed Clere raised earlier this month: The factory worker father and the retail clerk mother who stay off welfare, but have little or no health coverage. A catastrophic health event bankrupts them.
“That’s a tough question, but I don’t think it’s unfair,” Long answered. “That’s why people say we've got to take a look at it. To jump into the pool right now, without a better idea, is something we have to be very cautious of. I’m not saying never, either. We don’t have enough answers.”
The problem with HIP is while it serves about 46,000 people, more than that are on a waiting list. The Medicaid expansion roll has been put in the 400,000 range.
While lawmakers talk about future health care costs, there is little acknowledgment that people at or just above the poverty line are turning up in Indiana emergency rooms, at a cost of close to $3 billion annually, a fact most Republicans don’t speak about.
The predominant GOP view comes in the context of taxation levels, as opposed to insuring the lower middle class. But by not opting to expand Medicaid, Indiana could take a pass on billions of dollars we've already paid in taxes.
House Minority Leader Scott Pelath, D-Michigan City, said, “We can’t afford not to do this. It is wildly expensive to keep sending people to the emergency room and it’s reckless not to proceed in a way that is already provided for us by law. There are people against it simply because they don’t like the president.”
Pence views Medicaid as a “broken” system “rife with fraud and waste.” He calls the Healthy Indiana Plan “innovative” and “good for the fiscal health of the state,” even though no one can project the costs.
The cynics suggest Pence is making a political decision to position himself for 2016.
The Indiana General Assembly and Pence may be at the calendar halfway point in the 2013 budget session, but in reality, the need for so much more information – and open, inquisitive minds to go with it – became abjectly evident on Wednesday.