INDIANAPOLIS (AP) - Gov. Mike Pence is battling with House lawmakers over
expanding health care coverage for roughly 400,000 Indiana residents, amid
concerns that the state’s health care program for the poor won’t be able to
handle the flood of new enrollees.
Supporters of a House measure that would expand coverage for more than
400,000 low-income residents are concerned the health savings account used
as part of the Healthy Indiana Plan could not handle the increase from the
40,000 residents enrolled in the program now. The program, which is
operating under a one-year “demonstration period” approved by the federal
government, has a waiting list of more than 40,000 residents.
"There are questions around whether that (account) would be a viable feature
on the proposed scale,” said House Public Health Chairman Ed Clere, R-New
Clere pulled the bill from consideration Thursday. A top Pence aide said he
pulled the bill after finding out in a Republican caucus Wednesday that he
did not have the support needed to pass the measure. The aide spoke on
condition of anonymity because caucus meetings are private.
Pence filed a waiver with the Centers for Medicare and Medicaid Services
last week seeking to use HIP as the vehicle for the Medicaid expansion. His
staff lobbied House Republicans heavily this week to ditch their plan and
wait for an answer from the federal government.
Another key difference between the Pence approach and the House’s: The House
bill would force Pence to expand coverage. Even though Pence filed the
waiver seeking the Medicaid expansion, his staff says he is waiting until he
hears back from the federal government before deciding whether to expand the
Pence argued last week in a letter to U.S. Health and Human Services
Secretary Kathleen Sebelius that Medicaid was “broken” and expanding it
carried too big a price tag for Indiana. He has not yet said how much using
HIP would cost, and his administration has argued that the number is not
relevant until the state receives an answer from CMS.
The Indiana Hospital Association is among the groups pushing hard for the
state to accept some type of expansion. The association estimates that $10.5
billion in federal aid is on the table over the next seven years. Lawmakers
in the House and Senate, meanwhile, are working on legislation that would
effectively expand Medicaid by building a HIP program for residents earning
up to 138 percent of the federal poverty line.
The cost to the state of any expansion stifled most debate in the Statehouse
until a few weeks ago. The actuary hired by the state pegged the cost of
expanding Medicaid at $2 billion over seven years and estimated the state
would pay more than $600 million over that same period as residents who
already qualified for Medicaid but had never enrolled were forced into the
program by the individual mandate.
The IHA released its own study estimating Indiana would pay $503 million for
the expansion, a major decrease due in part to its expectation that doctors
treating Medicaid patients would be reimbursed at 60 percent of the rate
paid by Medicare. The state’s actuary assumed that rate to be 80 percent.