BRIAN HOWEY: Obamacare and the need for hard questions

2013-08-11T00:00:00Z BRIAN HOWEY: Obamacare and the need for hard questionsBy Brian Howey
August 11, 2013 12:00 am  • 

On Aug. 24, 2001, a French stuntman named Thierry Devaux tried to bungee jump from Lady Liberty's torch in the New York Harbor. He ended up dangling on his parasail from her wrist.

It was a whimsical moment that delighted tourists, cable news producers and viewers across the globe. New York Mayor Rudy Giuliani would call the thrill-seeking "Terry Do" an "idiot" as the moment disappeared into the late summer haze and, a few weeks later, a maelstrom.

That, of course, would be the Sept. 11 terror attacks just across the harbor. "Terry Do" became terror pilots, the World Trade Center towers fell, and everything changed.

Indiana's political and policy establishment has been riveted by a series of emails from former Gov. Mitch Daniels and former Superintendent of Public Instruction Tony Bennett that has now led to an investigation in the A-to-F school grading program. Earlier this year, everyone was obsessed with Gov. Mike Pence's income tax cut.

The real billion dollar story — the maelstrom on the brink — is Obamacare and the impact it is going to have on hundreds of thousands of poorer Hoosiers, tens of thousands of families, the state's community hospital systems, local safety net organizations, the more than $10 billion Indiana lawmakers might leave on the table, and the next generation of state and local budgets.

There are so many facets of this story we don't know about, this is essentially a call to action for the various news organizations, reporters and opinion shapers to go out into their communities — and into the Indiana Statehouse and agencies — and begin to ask the hard, penetrating questions.

Right now, we have about a thimble full of relevant information on this topic, and there is an ocean of data to process.

So much of the debate over Obamacare has taken on sharp, partisan and ideological trimmings. But the fact is, it's the law of the land and it is going to require pragmatism to deal with the myriad impacts.

Right now, Indiana's leaders are preoccupied with mostly denouncing Obamacare and calling for a repeal. U.S. Rep. Marlin Stutzman has talked about it in the context of a potential government shutdown rather than fund Obamcare, though he says there is plenty of time to negotiate.

And in Galesburg, Ill., on July 24, President Barack Obama reiterated his stance that the reform would move forward. There was an election about nine months ago, and American voters re-elected Obama and a Democratic Senate, while Hoosiers sent Democrat Joe Donnelly to the upper chamber.

Pence and those who loathe Obamacare can wish and wish and wish it to go away. But Republican U.S. Sen. Dan Coats has told me that a repeal is unlikely. Others talk about repeal after Obama leaves office, but the entire medical and insurance industry will be settled into the new law, and there’s no guarantee the next president will be a Republican.

Pence is seeking a waiver from U.S. Health and Human Services to extend the Healthy Indiana Plan for the 37,000 now enrolled. He wants to use it as an expansion.

It appears Indiana's leaders are putting all the eggs into repeal or the HIP expansion. But multiple sources who have worked on health issues in Indiana tell me it is unlikely the federal government will accept HIP as an expansion vehicle, and even if they do, it will be dramatically changed. It would have to in order to absorb up to 400,000 more enrollees.

Several sources have characterized the dynamic between Pence and the Obama administration as a historic "game of chicken."

Pence has vowed never to expand traditional Medicaid. The option in that scenario is that Indiana then leaves about $10 billion in federal funding (which Hoosier taxpayers contribute) on the table.

Question for local reporters and editors: What happens to your local hospitals should this occur?

My sources say local medical community leaders are walking a tightrope. Many are conservatives skeptical of Obamacare. But the loss of Medicaid funding poses a huge dilemma. They are reluctant to alienate Pence at this point.

What happens to the urban medical centers that get the "disproportionate share hospital" payments for serving large indigent populations? This would include Wishard in Indianapolis, Parkview in Fort Wayne and Methodist in northern Lake County.

I have Republican sources in the medical community and at the Statehouse who acknowledge, "That's a valid concern." Some believe it will lead to a crisis and cost taxpayers more in the long run.

Family and Social Services Administration Commissioner Debra Minott suggested in June that without a Medicaid expansion, “We will be making sure they are aware of the community health centers in their communities, free clinics that are available in multiple places around the state and other safety net-type resources.”

Local reporters should be asking their community safety net organizations about their current needs and ability to expand services.

There is so much work to do, so many questions to ask, and our leaders need to have a candid, pragmatic discussion with residents. Virtually none of this is happening now.

Brian Howey is publisher of Howey Politics Indiana. Follow him on Twitter @hwypol. The opinions are the writer's.

Copyright 2014 All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Follow The Times

Latest Local Offers

Featured Businesses

Submit a Letter to Editor

We welcome letters from readers on any issue of public interest, and make every effort to publish as many as we can and in a timely manner. The Times will publish only one letter a month from a writer, and be sure to include your name, address and a telephone number for verification. Letters should be 150 words or less. They will be edited.

Letters may be submitted:
  • Via our submission form.
  • Via e-mail.
  • Via fax: (219) 933-3249 or (219) 465-7298
  • Via mail or by hand to our offices:
    • 601 45th Ave., Munster, IN 46321
    • 2080 N. Main St., Crown Point, IN 46307
    • 1111 Glendale Blvd., Valparaiso, IN 46383
    • 3410 Delta Dr., Portage, IN 46368
    • Please mark envelopes with "Attn: Letters"


Email Editorial Page Editor Doug Ross or call (219) 548-4360 or (219) 933-3357



Who do you support for the U.S. House of Representatives in District 1?

View Results