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Opinion

September 9, 2013

BRIAN HOWEY: Health care amidst the amber waves of grain

State leaders have some soul-searching to do.

Gov. Mike Pence achieved a bureaucratic goal early last week when the Obama adminis-tration signed off on a one-year extension of a federal waiver for the Healthy Indiana Plan.

He immediately declared it a “victory for Hoosiers enrolled in this innovative program and will ensure that Indiana remains at the forefront of consumer-driven health care in the United States.”

But is this a victory for Hoosiers?

First, let’s do some math.

This is a state of 6.5 million people. In an interview with Gov. Pence last Tuesday, he put the uninsured population at 880,000. In the state’s biennial budget passed last April, it provided funding for an additional 90,000 Hoosiers to be covered under the pre-Obamacare Medicaid system. At the insistence of Senate Appropriations Chairman Luke Kenley, R-Noblesville, about $400 million was placed in the budget to cover a full extension of Medicaid under President Obama’s Affordable Care Act.

“We think 500,000 will be eligible for participation in the premium tax credits for the health care exchanges,” Pence told me. The current Healthy Indiana Plan covers 36,600, and there are 55,000 people on the waiting list. As part of the federal waiver through 2014, HIP enrollment will expand by 15,000 people. “We’ll be just shy of 50,000,” the governor said.

That puts the pool of uninsured around 300,000.

The governor wants to use the Healthy Indiana Plan as the vehicle for Obamacare-era Medicaid expansion. “In terms of the where to go from here, we just cleared our first prerequisite,” Pence said. “My other two prerequisites in Medicaid expansion are: It has to preserve elements of the consumer-driven model of the Healthy Indiana Plan, and it has to be fiscally responsible and sustainable.”

Under Obamacare, 100 percent of the Medicaid expansion will be covered for the first three years, and then 90 percent in perpetuity. “That 10 percent we would have to pick up in the long term is a very significant expense for the state of Indiana,” the governor said.

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