INDIANAPOLIS — Gov. Mike Pence is aiming to extend health coverage to hundreds of thousands more Hoosiers with his own twist on the Medicaid expansion found in President Barack Obama’s signature health care law.
The Republican governor was scheduled to unveil the strategy – which hasn’t yet been submitted to federal officials for approval – Thursday morning at an Indianapolis hospital.
Some 350,000 uninsured Hoosiers could receive health care coverage under Pence’s proposal that expands Indiana’s publicly-supported health program for low-income residents, known as the Healthy Indiana Plan. In some cases, the governor’s proposal – designed to help some of Indiana’s poorest residents gain access to health care – would require participants to make monthly payments to receive coverage.
The governor is saying he'd rather insure 350,000 than 45,000. How do I complain about that?" said State Rep. Ed Delaney (D-Indianapolis). "We have made some steps forward. We'll find out over time whether requiring relatively modest payments for beneficiaries improves things or not."
Pence’s proposal would provide health coverage to low-income adults and to the same population targeted under the Affordable Care Act’s Medicaid expansion.
Yet, Republican leaders have characterized the proposal as an alternative to Medicaid and a departure from the traditional program Pence has labeled as “broke and broken.”
Pence’s proposal, named “Healthy Indiana Plan 2.0,” divides the coverage into two tiers and features health savings accounts and individual contributions – hallmarks of the program that former Indiana Gov. Mitch Daniels created. Pence has touted the program as better than traditional Medicaid because of its emphasis on personal responsibility.
“There are two futures in health care – government-directed health care or consumer-driven health care,” Pence said in a prepared statement. “Indiana has chosen consumer-driven health care and intends to give eligible Hoosiers the power to make their own health care decisions through (Healthy Indiana Plan) 2.0.”
An estimate by the state shows Pence’s proposal will cost less than a traditional Medicaid expansion because the design “bends the cost curve,” though no firm numbers were provided. The state’s cost to expand the program between 2015 and 2020 is estimated at $1.5 billion and will be funded by revenue from the existing cigarette tax and an assessment paid by Indiana hospitals.
Fifty-two-year-old Beth Murphy has asthma and thyroid problems. She said she believes the new plan is tailor-made for her.
"I make too much for the HIP that they have now and I don't make enough for regular insurance. So I really think this will help me so I can have health coverage," Murphy said.
If approved by the federal government, the proposal allows the state to access federal Medicaid funding made available through the Affordable Care Act. The federal government would pay for all the cost associated with new enrollees through 2016, and then the federal share gradually declines to 90 percent by 2020. The state plans to increase an assessment paid by licensed hospitals to help cover the program once the federal government’s payment decreases.
A 2012 U.S. Supreme Court ruling made it optional for states to expand Medicaid. Indiana is requesting a waiver from the federal government to expand health coverage in its own way but still access federal funds to help pay for new enrollees.
The proposed plan would be available for Hoosiers ages 19-64 that make no more than $16,105 a year or $32,913 for a family of four. If approved by the federal government, the state hopes to roll out the new coverage in 2015.
The Federal Health and Human Services Department released a statement about the plan on Thursday saying it was "encouraged by Indiana and Gov. Pence's commitment to helping cover more of the state's uninsured population."
The first tier would cover the poorest Hoosiers, who choose not to make contributions to a health savings account. The plan is characterized as the “default plan” for participants earning less than $11,670 a year. The plan requires co-payments for services and the state would provide $2,500 for participants to use to meet their annual deductible. The first tier is also designed to alleviate federal health officials’ concerns because participants below the federal poverty line aren’t required to make monthly contributions to the plan to still be enrolled.
The second tier is available for Hoosiers earning no more than $16,105 a year. The plan is available to participants who contribute $3 to $25 a month to a health savings account, which the state would chip in to bring to $2,500. The plan includes vision and dental insurance and a comprehensive prescription drug benefit. Participants earning more than $11,670 would solely have access to the second tier plan and would run the risk of losing coverage if they don’t contribute to their health savings account.
The state’s waiver request to use the revised Healthy Indiana Plan as a vehicle for Medicaid expansion would cover a five-year period. As a back-up plan, the state also is submitting a request to continue the state-run plan as currently designed in case the federal government doesn’t approve the new version, though that plan would cover less people.
The waiver will be available for public review at www.hip.in.gov. The state will take public comment on the plan for 30 days. Two public hearings also will be held in Indianapolis later this month.
Pence’s administration is preparing to submit the waiver request for the federal government’s consideration by June 30.
Here are the differences between the current Healthy Indiana Plan and Pence’s proposal:
Current Healthy Indiana Plan:
• Capacity of program at 45,000 and enrollment subject to availability of funds
• Eligible for adults earning no more than $11,670 a year or $23,850 for a family of four
• Health savings account amount is $1,100 and participants who fail to contribute are kicked off for 12 months.
Proposed “Healthy Indiana Plan 2.0:
• No enrollment cap for eligible Hoosiers
• Eligible for adults earning no more than $16,105 a year or $32,913 for a family of four
• Health savings account amount is $2,500. Participants earning more than $11,670 per year must make monthly contributions to account or risk losing coverage for six months. Participants making less but choosing not to contribute to account moved onto plan with less coverage.