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Medicaid expansion not dead but Legislature still divided

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When talking about expanding Medicaid under the provisions of the Affordable Care Act, both sides of the aisle in the Statehouse focus on the same point – costs.

Talk of the health care program for low-income Hoosiers dominated separate press conferences by party leaders Wednesday. Senate President Pro Tempore David Long, R-Fort Wayne, repeatedly emphasized his concerns over the potential cost to taxpayers while Senate Democratic Leader Tim Lanane, D-Anderson, and House Democratic Leader Scott Pelath, D-Michigan City, raised questions about the expense associated with not expanding the program.

The debate over whether Indiana should grow its Medicaid program to conform with health care reform is certain to continue in the Statehouse. Senate Bill 551, authored by Sens. Patricia Miller, R-Indianapolis, and Luke Kenley, R-Noblesville, passed through the Senate on the final reading day and is now moving to the House of Representatives. In the House it is being sponsored by Ways and Means Chairman Rep. Tim Brown, R-Crawfordsville.

SB 551 seeks federal approval to expand Medicaid under Indiana’s own terms. Specifically the bill continues negotiations with the U.S. Department of Health and Human Services to allow the state to do its expansion through the Healthy Indiana Plan. It also directs the secretary of the Family and Social Services Administration to ask the federal government to provide Medicaid funding in the form of a block grant to give Indiana greater flexibility in administering the program.     

Under the provisions of the Affordable Care Act, states that opt to expand their Medicaid programs to cover individuals with incomes up to 133 percent of the federal poverty level will have the cost of the expansion covered by the federal government at 100 percent for three years starting in 2014. Then the ratio will gradually decline to a 90-10 split by 2020.

Long said the other state legislature leaders, both Republicans and Democrats, whom he has spoken with from around the country, share his skepticism that the federal government will end up shouldering 90 percent of the costs.

“You continue to see reports that the cost of this program going way above what the estimates were,” Long said. “How are you going to pay for that? I’ll tell you, they’re (the federal government) going to pass it along to the states is what they’re going to do. I believe that. That’s the federal system, pass it down to the states.”

Pelath countered not expanding Medicaid in a way that is already provided by the law is reckless.

“They only want to focus on the costs that they want to talk about,” he said of the opponents to the expansion. “They don’t want to talk about the cost of emergency room care, they don’t want to talk about the costs of people who don’t get the health care they need and end up getting sicker. The fact of the matter is that we have to provide health care in a better way because we can’t afford the system we have now.”

Long did not shut the door on any potential comprise but he still raised issues about doing an expansion under the Healthy Indiana Plan. The costs of working within the HIP framework are unknown, he said, and likely to be a significant expense to taxpayers.

“I do think the federal government will have to back off and allow the states some innovative ways to implement the expansion,” he said. “That’s what we ought to continue to wait for. If they do, they we’ll sit down and talk about it. But the cost factor right now, it’s scary and it should scare a lot of people.”


 
 

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