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INDIANAPOLIS — Approximately 130,000 Hoosiers enrolled in the Healthy Indiana Plan soon may be required to work at least 20 hours per week to continue receiving state-supported health coverage.

On Wednesday, Republican Gov. Eric Holcomb asked the federal government for permission to replace HIP's voluntary employment referral program with a work mandate, starting in mid-2018.

When fully phased in, able-bodied adults who fail to work at least 20 hours a week in eight months of the year would be suspended from HIP until the person again satisfies the employment requirement for at least one month.

The mandate would not apply to some 300,000 HIP members who are full- or part-time students, pregnant women, primary caregivers for young children or disabled dependents, over age 60, medically frail, temporarily disabled, in a drug treatment program or recently released from prison.

HIP members unable to find work still could satisfy the mandate and preserve their health coverage by participating in verified job skills training, job search activities, vocational training, community service or volunteer work.

Holcomb said the change is needed to ensure Indiana has "a healthy workforce" to meet the demand for "approximately 1 million new skilled workers to replace retiring baby boomers and fill jobs being created by Indiana's dynamic economy" over the next decade.

The governor indicated that he was inspired to seek permission to add a HIP work requirement after federal health officials announced their support for states to design programs that meet their needs.

In recent weeks, Republican President Donald Trump and the Republican-controlled Congress also have signaled that they favor employment mandates as a condition of Americans receiving food stamps, public housing, welfare benefits and Medicaid.

State Rep. Charlie Brown, D-Gary, the architect of the original 2007 Healthy Indiana Plan, cautioned that adding a work mandate to HIP could take the state back to the bad old days where uninsured Hoosiers relied on emergency rooms for health care and those high costs were passed on to everyone else.

"I don't like this at all," Brown said. "Health care is a right and not a privilege, and one day, maybe not in my lifetime, we're going to get to the point that we provide this to folks regardless of their employment status, regardless of their economic status even."

The current Healthy Indiana Plan 2.0 was established by Republican Gov. Mike Pence in 2015 as an alternative to traditional Medicaid expansion under the Affordable Care Act, also known as Obamacare.

One way Pence sought to distinguish HIP from Medicaid was to provide job search assistance to participants that ultimately would enable them to quit HIP after securing health insurance through their employers.

That effort failed miserably with just 580 HIP members participating in Gateway to Work services during the first 15 months of the program out of some 302,000 members who were either unemployed or working fewer than 20 hours per week.

The state claims that adding a work mandate to HIP will get more members into job training programs, which will lead to "decreased unemployment for Hoosiers and improved health and financial stability for members."

The federal government is expected to decide by November whether to accept Holcomb's proposed HIP change.

However, the program separately faces an existential threat that could effectively eliminate it altogether.

About 95 percent of HIP funding comes from the federal government using taxes that were increased by the 2010 Affordable Care Act.

If Obamacare is repealed that funding may not be restored.

Indiana then would have to choose between filling a $2 billion annual budget hole with higher state taxes or sharp reductions to HIP enrollment that would leave only the poorest and sickest still covered.

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