INDIANAPOLIS | How is Indiana going to ensure health insurance to the “working poor?”
State Rep. Ed Clere, the New Albany Republican who chairs the House Public Health Committee, defines this estimated pool of 400,000 Hoosiers like this: “These are people who are doing exactly what Republicans want them to do. The father works in a factory. The mother is a retail clerk.” They are more than likely to be Republicans.
Together, they might bring in $40,000 to $50,000 a year. But the factory and the retail store don’t provide health insurance, and even if they do, in many cases it’s a flimsy policy.
“If they have a major health issue, they face a financial disaster,” Clere said.
Or as Dr. Aaron E. Carroll of the Indiana University School of Medicine, told the committee, “The choice for many isn’t between Medicaid and some private insurance. The choice is between Medicaid and nothing.”
If you’re poor and below the poverty level, you’re covered by existing Medicaid. If you’re rich or in the middle to upper levels of the middle class, your employer provides or you buy a health insurance policy that could cost your family between $10,000 and $20,000 a year.
There is no question: Hoosiers don’t like “Obamacare.”
But here’s the indisputable reality: The Affordable Care Act became a long-term reality when President Obama defeated Mitt Romney last November. It’s the law of the land.
Indiana must now make decisions on how it will participate. And in the next weeks and months, decisions that could impact 400,000 working Hoosiers with billions of dollars of implications will be made by Gov. Mike Pence and the Republican-dominated Indiana General Assembly.
The Medicaid debate came as Gov. Mike Pence -- parting ways with GOP governors in Michigan and Ohio -- issued an ultimatum to Health and Human Services Secretary Kathleel Sebelius this past week. Pence has ruled out expanding Medicaid under the federal health care law unless Indiana gets approval to use its Healthy Indiana Plan savings accounts for the expansion.
On Wednesday, he reiterated that stance, with his office saying the governor “flatly refused to expand the traditional Medicaid program in Indiana.”
In a letter to Sebelius, Pence requested federal approval to use the Healthy Indiana Program to serve an expanded Medicaid population.
Bills in the Indiana House and Senate advanced on Wednesday that pave the way for HIP to be the framework of services, though no one can say what those costs will be.
The Healthy Indiana Program currently provides health coverage for about 40,000 Hoosiers, though there are another 46,000 people on the waiting list. So with the governor ruling out a Medicaid expansion, the question is, what happens to the 350,000 to 400,000 “working poor” Hoosiers?
Clere cited the innovative Indiana health care programs -- Hoosier Healthwise in 1995 and the Healthy Indiana Plan in 2008. He said HB1591, which would expand Medicaid, “takes the lessons of existing programs” and operates in a way that is “predictable and respectful of the Hoosier taxpayer.”
The decisions coming in the next week and months come with billions of dollars at stake. The federal government will cover upwards of 95 percent of the Medicaid expansion until 2020 and 90 percent thereafter. If Indiana declines, it could cost the state billions of dollars.
And we’ve done this before.
Back in the early days of the Environmental Protection Agency, the federal government made billions of dollars available to states to correct its widespread combined sewer overflow problem. But because of ideology and a disdain for federal aid, Indiana passed the opportunity up.
Hoosier office holders in the 1950s and 1960s did the same with federal school lunch program dollars.
And in the early 1960s, the Indianapolis Public School board voluntarily desegregated its schools, then rescinded the decision a year later. The result was a federal busing order that prompted “white flight” and more than a billion dollars in busing costs over the ensuing three decades.
So the decisions at the Indiana Statehouse made between now and April will impact scores of hardworking and vulnerable Hoosiers for years to come. The flow of these federal dollars could bring about 30,000 jobs as hospitals expand.