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Debate over health care expansion heating up

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In a year when the Indiana General Assembly is working on a new state budget, the debate over whether to expand Medicaid is illustrative of how murky those dollars and cents figures can be.

Take a recent exchange between Sen. Luke Kenley, R-Noblesville, and Sen. Greg Taylor, D-Indianapolis. During a legislative panel at the Indiana University Robert H. McKinney School of Law, the senators, both members of the Senate Tax and Fiscal Policy Committee, disagreed over the cost of the expansion.

Kenley argued that, at present, Indiana’s Medicaid program costs $6.4 billion. The state pays $2 billion and the federal government is making up the remaining $4.4 billion.
 

senatorskenley-luke-15col.jpg Sen. Luke Kenley, R-Noblesville, and Superintendent of Public Instruction Glenda Ritz answer questions during a legislative panel held recently at I.U. McKinney School of Law. (Photo courtesy of David Jaynes)

Even absent an expansion of eligibility, Medicaid will cost the state $9.7 billion by 2015. While the federal government will pick up the tab for $2.3 billion of that additional cost, Indiana will have to come up with an additional billion.

With the state diverting more money into Medicaid, any discussion about increasing funding for education and roads will be off the table, he said.

“This one issue is going to drive the entire state budget,” Kenley said, “and it’s going to threaten the sovereignty of every state in the country unless we get some kind of massaging effect out of Washington to help us figure out how to deal with this.”

Taylor countered that the expansion will be covered by the federal government. The amount the state is paying now will be the amount the state will pay for the next three years even as Medicaid expands because Washington, D.C., will be funding the growth 100 percent.

“I don’t care where we start, the difference when we expand our Medicaid, any increase will be paid for by the federal government,” Taylor said. “That’s one of the most important pieces of the puzzle that we have not heard.”

The debate over whether to expand Medicaid was kicked off when the U.S. Supreme Court handed down its decision on health care reform.

Historically, the program, which provides health care coverage to low-income individuals, has been funded with state and federal dollars. The Patient Protection and Affordable Care Act somewhat alternated that formula by requiring all states to expand eligibility for their Medicaid programs to 133 percent of the federal poverty level. States that did not comply risked losing all their federal Medicaid dollars.

However, with National Federation of Independent Business v. Sibelius, 567 U.S. _ (2012), the Supreme Court equated that provision with putting a “gun to the head” of the states. It struck down that section and, in turn, that opened the door for states to decide on their own if they would grow their Medicaid programs.

Even as the Indiana General Assembly debates, Hoosier hospitals and health care providers have mostly made their decision. To fend off the cuts in Medicare, hospitals, through the Indiana Hospital Association, are asking the Legislature to expand Medicaid.

Providing more indigents with health care coverage would alleviate the burden of uncompensated care, said Brian Tabor, vice president of government relations at the Indiana Hospital Association. In 2011 alone, Indiana hospitals provided nearly $3 billion in medical care for which they did not receive any payment.

Hospitals and medical providers have already been hit with cuts in Medicare reimbursements since 2010. Over the next decade, Indiana hospitals are expected to see a reduction of $3.8 billion because of these cuts.

As part of the design of the ACA, the federal government cut Medicare, the health care program for seniors, to help pay for the expansion of Medicaid. The idea is that the Medicaid expansion will provide more individuals with coverage which will lower the amount of uncompensated care. In turn, hospitals will make up for the lower Medicare reimbursements by having more paying patients.

Nationally, the $155 billion in cuts to Medicare are expected to be offset by $170 billion in payments from the expanded Medicaid and health care exchanges covering the uninsured, according to Tabor.

“I think Indiana would be foolish to pass it up,” David Orentlicher, Samuel R. Rosen Professor of Law at the I.U. McKinney School of Law, said of the Medicaid expansion.

Under the ACA, the federal government will pick up the tab for the expansion at 100 percent for three years starting in 2014. It will gradually phase down to 90 percent reimbursement in 2020.

Orentlicher compared it to a free trial. The state could try the expansion for three years then decide whether to continue.

Without the expansion, some hospitals could close or shed services, Tabor said. Some of the 126,860 jobs in Indiana hospitals would be at risk as well.

Tabor also predicted the impact could trickle down into the larger community by forcing individuals to go outside their own neighborhood or town for medical care. In addition, it could hinder economic development since companies are unlikely to want to operate in a community that does not have a hospital which offers complete services, he said.

The expansion, in Kenley’s eyes, is about more than money.

Health care reform dramatically altered the relationship between the federal government and states, he said. Before, states administered Medicaid pretty much as they wanted. Now, under the ACA, the federal government is telling them how to administer the program, reducing the states’ role to that of a clerk.

“They are taking away our authority and our discretion to make certain types of decisions within the system,” Kenley said.

To get control back, he has asked Gov. Mike Pence to enlist as many other governors as possible and argue vociferously for block grants. Turn over the money, loosen the regulations and let the states develop a health care system that could perhaps cover more people and increase efficiency so costs are pushed down, he said.

Full expansion of Medicaid through 2020 would make coverage available to about 500,000 Indiana residents and cost the state $516 million more per year, according to a study by Milliman Inc. The estimate also includes the “woodwork effect” whereby those individuals who are already eligible for Medicaid under the current guidelines but have not enrolled would come into the program to comply with the ACA mandate that all individuals carry health insurance.

More difficult to determine are the potential savings realized by expanding Medicaid.

Along with reducing the instance of uncompensated care, Tabor pointed out by increasing coverage, less of those unpaid costs would be shifted to private insurance. In addition, the overall health of Indiana residents could improve because individuals would be able to afford care and no longer wait to seek treatment until the medical condition becomes acute.

On Jan. 16, Democrats in the Statehouse tried to jumpstart the push for implementation of the ACA by offering Senate Bill 540 which calls for the establishment of both the Medicaid expansion and health care exchanges. The bill is authored by Sen. Karen Tallian, D-Ogden Dunes.

In announcing the bill, the minority party addressed the issue of savings, noting the state could offset costs of the expansion and exchange by realizing reductions in medical funding in the Department of Correction and mental health initiatives.

Tallian is uncertain of the bill’s future. However, she recognizes the effort to get the Legislature to act will likely get some outside help. Businesses and hospitals, already dealing with ACA costs, will put pressure on the Statehouse to expand Medicaid.

“I think there are a certain number of states who did a sort of knee jerk reaction that ‘We don’t like Obamacare, we’re mad that it ever passed and we’re not going to play,’” Tallian said. “I think that will eventually go away.”•

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  1. Am I the only one who sees that the City is essentially giving away the MSA site AND giving millions to build new buildings on the site when this site would be the perfect place for the Justice Complex? Across from City-County, check; keeping it centrally located, check, etc. It's my understanding that the GM site must be purchased by the City from Motors Liquidation Company. STOP WASTING WHAT WE ALREADY HAVE AND OUR TAX DOLLARS! The Ballard Administration has not been known for it's common sense...never voted for him and never will!

  2. This guy sounds like the classic molester/manipulator.

  3. Louis D. Brandeis was born in 1856. At 9 years of age it would have been 1865. The Brandeis family did not own slaves. My source Louis D. Brandeis: A Life, by Melvin L. Urofsky.

  4. My name is Matthew Lucas Major, I recently went through a jury trial in Bloomington , In. It was the week of Feb 19-21. Although I have been incarcerated since August 5, 2014. The reason I 'am writing to you sir is on the 21 of February the jury came in with a very excessive and wrongful verdict of guilty on 6 child molesting charges against my daughter who was 9 at the time I was accused. I also had 2 other Felonies one of Intimidation and 1 of Sexual Vicarious Gratification. Judge Marc Kellam on the second day of trial gave me a not guilty on those 2 felonies. The jury was sent out during that time and when brought back Judge Kellam told them to not concern themselves with the 2 Felonies that he ruled on them. They were told to not let evidence they had already heard influence there verdicts. I never in my life touched any child sexually and definitely not with my own daughter. When I was arrested Detective Shawn Karr told me I would be convicted guilty just on my daughters word even without evidence. That's just what happened. my public defender did me so wrong he never once proved to the court and jury all the lies the child told, and Jeremy Noel my public defender could of proven the lies easily. The stories in Serenity's depositions and Forensic interview changed and were not consistent as Prosecutor Darcie Fawcett claimed they were. Yet my attorney never mentioned that. The facts that the child accused me of full penetration in her vagina and rectum was proven lies. Doctor Roberta Hibbard of Riley hospital in Indianapolis confirmed Serenity's hymen intact, no scars, no tearing, no signs of rape to her. Yet my attorney didn't use that knowledge . the DNA was all in my favor. I tell you I will spend my entire life in prison going through rape and beatings etc. even Judge Kellam abused his authority by telling the jurors to listen and believe what the prosecutors side in evidence like my daughters testimony. In one interview with the detectives my daughter got flustered with her mom and said on camera " I'm saying what you told me to mom"!! Yet Mr. Noel said nor did anything to even resemble a defense attorney. Judge Kellam allowed edited version of a taped conversation between the child and her mother. Also Judge Kellam allowed the Prosecutor too bring in to my case a knife found under my seat, the knife wasn't part of my case. She was allowed by my attorney and the judge to put a huge picture of it on the screen and huge picture of my naked privates in a full courtroom and open court. Ms. Fawcett says to jury see how easy Mr. Major could reach the knife and cut his Childs throat. Even though I had no weapons charge against these cases. This gave the jurors prejudice thought against me thinking I threatened her with that knife and how scared she would of been knowing i could get it and kill her. On my sentencing court March 19, 2014 my public defender told Judge Kellam he wish to resign from being my attorney and wished for the court to give me outside council to file a error to trial or appeal. We were denied. Now after openly knowing my public defender don't want to represent me he has to. Well when as parents we make our kids clean a room when they really don't wish to, well the child will but don't mean she will do a good job, that's where I'm at with Mr. Noel. please dont ignore mine and my families pleas for your help . we have all the legal proof you could need to prove Im innocent. Please dont make my spend years in prison innocent when you can fix this wrong. Im not saying Im a perfect man or that I was a perfect dad to my 2 children none of us are. Ive made some bad choices in life and I paid for them. But I didnt ever touch or rape my daughter . I love my children with all my heart. And now through needing attention and a ex-wife who told my granny several times she wish she could put me in prison to get me out of their lives. Well my ex finally accomplished her goal. Sad part is she is destroying our daughter with all this horrific lies and things she taught my daughter to say. My daughter will need therapist to ever hope for a chance of a normal life after what she had done to her by her mom and their side of the family. My daughter told everyone even on stand she had a dream months before i supposedly molested her in this dream I was molesting her and when I finally did it matched her dream perfectly. She admitted to watching movies about little girls being molested and watching U-Tube videos about child molesting all before it happened supposedly to her. Doesn't that sound very unusual that a non molested 9 yr old would need to know so much about being molested? The only reason I could think a 9 year old would need so much information is to be prepared to know what to say and be able to say how it felt what took place etc.. So when questioned by authorities she would be prepared. And there again sir if a parent is pre grooming a 9 year old child she would need intimate details . Like telling her daughter about a couple moles on my private area. The child admitted to sneaking my cell and looking many many times at nudes of me and my girlfriend even one where my penis was entering my girlfriends vagina. In that picture my moles are obvious. Yet when prosecutor showed everyone in court my privates and pictures of the moles she said the only way the child would know about them is if she saw them for herself. My attorney once again said nothing about the pictures my child saw. Or could a ex-wife be able to describe my moles to help her case against getting rid of me? I beg you help me. This is my very existence. Ive lost everything , a good job, a wonderful girlfriend, my freedom, but worse thing Ive lost is my children. They were my reason to get up every morning and strive to be better. The wonderful bond I had with my Serenity is gone. After this I would be afraid to even hug her for fear of what next can they do to me. I'm not afraid to tell you I sit here in this cell and try to hold back my tears. Everyone knows you cant show weakness in prison. My life has already been threatened here at Wabash Valley Prison. After only 3 days of arrival. I was tricked into signing a waiver now Im in G Block General Population with 6 child molesting felony charges. Mrs. Hart as a 18 year old I almost died hooked to machines in hospital almost 1 month and now I know that fear was childish compared to this . I cant help but put emotions in this, after all Mrs. Hart Im human and God help Me I never been more afraid in my life. I didnt hurt my little girl I didnt touch her sexually. As much as it shreds me and fills my mind what Im facing I worry more about my mom and granny because of their great love for me mam they are suffering so deeply. I aint done this things but my loved ones suffering right along beside me and If you take my case you will be in essence freeing them also. I sent momma this letter and asked her to email it to you. I'm scared I have been done so unjustly by our legal system and I need you to fix this and give me freedom. I ask you please don't just ignore my pleas. Here in America its nice to be able to trust our legal justice system, well they destroyed my and my loved ones trust in our justice system . And I'm trusting in You !!! My entire family is suffering this nightmare with me. My 77 year old granny had a stroke and isn't doing so well. My single mother that raised 3 kids alone is dying from Lupus and since my arrest has stayed so sick and weary. Our lives torn to peices by a government I was taught I could trust in. my momma has tried so many innocent project and wrongfully accused and cant get anywhere. please please help me. A quote from the late Nelson Mandela: To be free is not merely to cast off ones chains, But to live in a way that respects and enhances The Freedom Of Others. I have Faith in you and your clinic to cast my chains off and give me freedom I do deserve as a wrongfully accused Man, son, brother, father, friend. Matthew Major DOC# 246179 Cause # : 53c02-1308-FA-000779 God Bless you. Please contact me with your decision so I know you made a life changing decision for me , just please at least write me so I know you care enough about your citizens to respond to cries for your help. You can speak openly with my mother Charlotte Spain (828) 476-0406: 71 Lakeview Dr. Canton, NC 28716 Thank You Matthew Major I know yall get thousands of request and inmates claiming innocence, and each person who are innocent deserve to have organizations like yours willing to fight for them and I give yall so much Thanks and I thank God everyday yall are out there caring enough to help free the innocents. Since discovering firsthand how easily lives and families can be destroyed by Poor Defense attorneys not doing their job . And Prosecutors allowed to do as they please in court

  5. Frankly, it is tragic that you are even considering going to an expensive, unaccredited "law school." It is extremely difficult to get a job with a degree from a real school. If you are going to make the investment of time, money, and tears into law school, it should not be to a place that won't actually enable you to practice law when you graduate.

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