Indiana Gov. Mike Pence's plan to expand Medicaid, but under his terms rather than the federal government's, is getting early praise. It's better than nothing, but it's not the best it could be.
It remains to be seen whether the federal government will approve Pence's complicated plan. I'm skeptical of both the plan and its chances for federal approval.
Pence is touting a "consumer-driven health care coverage program for low-income adults that builds on Indiana’s history of consumer-driven health care." But the sticking point is the money the patient must pay each month.
Indiana will require participants to pay $3 to $25 a month. That doesn't seem a lot to most of us, but when you're so poor you qualify for this plan — at less than 138 percent of the low federal poverty level — that amount can be a big problem. When your food, shelter and transportation eat up your budget, you might not have anything left for health care.
Contrast that with extending the traditional Medicaid program under the federal government's terms, in which the patient doesn't have to pay, and you'll see a big difference. So will the consumer.
"Consumer-driven" sounds good, but how many patients with bronchitis are going to phone around to check prices before seeking medical care? And what health care provider is going to give a price without knowing the diagnosis or even all the symptoms and medical history?
In general, the idea should be to provide affordable health care coverage so the patient gets routine care on a routine basis, rather than waiting until the situation gets so bad an emergency room becomes the family doctor.
The definition of "affordable" becomes more clear when you have little money to begin with.
Democrats are commending Pence's plan, knowing it's really a Medicaid expansion whether he wants to admit it or not, but don't forget the sticking point of the patient contribution. I doubt the feds will like it.
Pence has said he wants to revamp Medicaid so it becomes like a block grant to the states so they can create their own health care programs for the poor. His Healthy Indiana Plan 2.0 is a step in that direction, if the federal Centers for Medicare and Medicaid Services approves it.
Pence has been negotiating with the federal government ever since he became governor. The state's fall-back alternative is to seek another waiver for the existing Healthy Indiana Plan, created in 2007 under Gov. Mitch Daniels' direction.
If all goes according to Pence's plan, HIP 2.0 enrollment would begin in 2015.
Any Medicaid expansion is better than none, to reduce the number of uninsured Hoosiers. This plan, though, could easily win a Rube Goldberg competition.
Whether it wins federal approval remains to be seen.