A coalition of Democratic senators and representatives gathered at the Indiana Statehouse Wednesday morning to “jumpstart the conversation” on health care exchanges and Medicaid expansion.

The exchanges and expansion are among the provisions of the Patient Protection and Affordable Care Act passed in March 2010. The six legislators said the federal law offers an opportunity to extend health care to all Hoosiers, yet they are dismayed there have been no discussions in the Legislature and no public dialogue on the implementation of the exchanges or the expansion.

Assistant Senate Democratic Leader Jean Breaux (R-Indianapolis) called the silence deafening.

Breaux and Sen. Karen Tallian, D-Ogden Dunes, used the press conference to announce their proposal, Senate Bill 540, which provides for the implementation of the federal ACA.

The bill has two parts. The first part addresses the insurance exchanges and calls for the establishment of a committee to study and make recommendations to the legislative council concerning the implementation of an exchange. The second part calls for changes in the Medicaid eligibility requirements to allow for the program’s expansion.

The coalition emphasized the $20 billion the state is expected to receive over the next seven years in federal health care spending which would not only provide health insurance for Hoosiers but also create 47,000 jobs.

The lawmakers also highlighted areas they believe costs will be cut if Medicaid is expanded. Tallian, in particular, pointed to the Department of Correction which currently spends $100 million annually on medical care for inmates. With the expansion, these inmates would be covered by insurance.

“These are just the direct benefits,” she said. “They say nothing about the value of making sure everyone has health insurance.”  

Under the ACA, states have the option of setting up their own health care exchanges or having the federal government establish and run the exchange in the state. Gov. Mike Pence has said he does not believe Indiana should create an exchange because it could cost the state millions of taxpayer dollars.

Originally, states had until Jan. 1, 2013, to decide if they would run their own exchanges or let the federal government do it. However, the Obama administration has indicated it will give states more time to make a decision.

The Supreme Court of the United States ruling which upheld most of the ACA noted states do not have to expand Medicaid.

Pence has also raised concerns about the cost to Hoosiers if Medicaid is expanded. However, because the increasing Medicaid coverage is predicted to reduce the number of non-paying patients, Indiana hospitals and medical practices are expected to pressure the Legislature to expand the program.