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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.

(Continued)

Thus, Pence is calling for a “modest” expansion of Medicaid under the Healthy Indiana Plan. And if the feds reject HIP for expansion, Pence is prepared to walk away.

And this is where a values element comes in — one every taxpayer, every lawmaker and our governor needs carefully to consider.

Asked what his message is to the insured citizens who essentially subsidize the 300,000 uninsured, Pence talked about a “broad range of services” to the uninsured, citing hospital charity care, the “Disproportion Share Hospitals” like Wishard in Indianapolis, Parkview in Fort Wayne, and community health centers. “Health care is available to most Hoosiers,” Pence said at Tuesday’s press conference. “Every person has the ability to walk into an emergency room.”

Pence acknowledged many community health professionals and local hospitals are concerned about what would happen if the federal government does not approve HIP for a full Medicaid expansion. Health care industry sources tell me the Healthy Indiana Plan is not designed for a full expansion and would likely be dramatically changed by the federal government. “It’s an honest disagreement,” Pence said.

Citizens in Elkhart heard it last Wednesday night when Elkhart General Hospital President Greg Losasso said his community would be “disadvantaged” without the federal funds that would come with a Medicaid expansion. In the first three years under Obamacare, the number Pence is prepared to leave on the table is $10.45 billion (Indiana’s biennial budget is $15 billion). Potential cost to the state between 2014 and 2020 range from $600 million to cover those “out of the woodwork” — or current Hoosiers eligible for Medicaid coverage — and up to $2 billion to cover 300,000.

My colleague from CNHI, reporter Maureen Hayden, has written a column every Hoosier should read that adds some stunning perspective to the stakes here. She reported 2.7 million Hoosiers sought care in hospital emergency rooms last year. Thirty Indiana counties have no obstetric services. Because of this lack of pre- and post-natal care, Indiana’s infant mortality rate is a stunning 7.7 per 1,000 babies, a full percentage above the national average. Of 35 “critical access” hospitals in rural Indiana, 11 of them are losing money.

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