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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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  1. Yes diversity is so very important. With justice Rucker off ... the court is too white. Still too male. No Hispanic justice. No LGBT justice. And there are other checkboxes missing as well. This will not do. I say hold the seat until a physically handicapped Black Lesbian of Hispanic heritage and eastern religious creed with bipolar issues can be located. Perhaps an international search, with a preference for third world candidates, is indicated. A non English speaker would surely increase our diversity quotient!!!

  2. First, I want to thank Justice Rucker for his many years of public service, not just at the appellate court level for over 25 years, but also when he served the people of Lake County as a Deputy Prosecutor, City Attorney for Gary, IN, and in private practice in a smaller, highly diverse community with a history of serious economic challenges, ethnic tensions, and recently publicized but apparently long-standing environmental health risks to some of its poorest residents. Congratulations for having the dedication & courage to practice law in areas many in our state might have considered too dangerous or too poor at different points in time. It was also courageous to step into a prominent and highly visible position of public service & respect in the early 1990's, remaining in a position that left you open to state-wide public scrutiny (without any glitches) for over 25 years. Yes, Hoosiers of all backgrounds can take pride in your many years of public service. But people of color who watched your ascent to the highest levels of state government no doubt felt even more as you transcended some real & perhaps some perceived social, economic, academic and professional barriers. You were living proof that, with hard work, dedication & a spirit of public service, a person who shared their same skin tone or came from the same county they grew up in could achieve great success. At the same time, perhaps unknowingly, you helped fellow members of the judiciary, court staff, litigants and the public better understand that differences that are only skin-deep neither define nor limit a person's character, abilities or prospects in life. You also helped others appreciate that people of different races & backgrounds can live and work together peacefully & productively for the greater good of all. Those are truths that didn't have to be written down in court opinions. Anyone paying attention could see that truth lived out every day you devoted to public service. I believe you have been a "trailblazer" in Indiana's legal community and its judiciary. I also embrace your belief that society's needs can be better served when people in positions of governmental power reflect the many complexions of the population that they serve. Whether through greater understanding across the existing racial spectrum or through the removal of some real and some perceived color-based, hope-crushing barriers to life opportunities & success, movement toward a more reflective representation of the population being governed will lead to greater and uninterrupted respect for laws designed to protect all peoples' rights to life, liberty & the pursuit of happiness. Thanks again for a job well-done & for the inevitable positive impact your service has had - and will continue to have - on countless Hoosiers of all backgrounds & colors.

  3. Diversity is important, but with some limitations. For instance, diversity of experience is a great thing that can be very helpful in certain jobs or roles. Diversity of skin color is never important, ever, under any circumstance. To think that skin color changes one single thing about a person is patently racist and offensive. Likewise, diversity of values is useless. Some values are better than others. In the case of a supreme court justice, I actually think diversity is unimportant. The justices are not to impose their own beliefs on rulings, but need to apply the law to the facts in an objective manner.

  4. Have been seeing this wonderful physician for a few years and was one of his patients who told him about what we were being told at CVS. Multiple ones. This was a witch hunt and they shold be ashamed of how patients were treated. Most of all, CVS should be ashamed for what they put this physician through. So thankful he fought back. His office is no "pill mill'. He does drug testing multiple times a year and sees patients a minimum of four times a year.

  5. Brian W, I fear I have not been sufficiently entertaining to bring you back. Here is a real laugh track that just might do it. When one is grabbed by the scruff of his worldview and made to choose between his Confession and his profession ... it is a not a hard choice, given the Confession affects eternity. But then comes the hardship in this world. Imagine how often I hear taunts like yours ... "what, you could not even pass character and fitness after they let you sit and pass their bar exam ... dude, there must really be something wrong with you!" Even one of the Bishop's foremost courtiers said that, when explaining why the RCC refused to stand with me. You want entertaining? How about watching your personal economy crash while you have a wife and five kids to clothe and feed. And you can't because you cannot work, because those demanding you cast off your Confession to be allowed into "their" profession have all the control. And you know that they are wrong, dead wrong, and that even the professional code itself allows your Faithful stand, to wit: "A lawyer may refuse to comply with an obligation imposed by law upon a good faith belief that no valid obligation exists. The provisions of Rule 1.2(d) concerning a good faith challenge to the validity, scope, meaning or application of the law apply to challenges of legal regulation of the practice of law." YET YOU ARE A NONPERSON before the BLE, and will not be heard on your rights or their duties to the law -- you are under tyranny, not law. And so they win in this world, you lose, and you lose even your belief in the rule of law, and demoralization joins poverty, and very troubling thoughts impeaching self worth rush in to fill the void where your career once lived. Thoughts you did not think possible. You find yourself a failure ... in your profession, in your support of your family, in the mirror. And there is little to keep hope alive, because tyranny rules so firmly and none, not the church, not the NGO's, none truly give a damn. Not even a new court, who pay such lip service to justice and ancient role models. You want entertainment? Well if you are on the side of the courtiers running the system that has crushed me, as I suspect you are, then Orwell must be a real riot: "There will be no curiosity, no enjoyment of the process of life. All competing pleasures will be destroyed. But always — do not forget this, Winston — always there will be the intoxication of power, constantly increasing and constantly growing subtler. Always, at every moment, there will be the thrill of victory, the sensation of trampling on an enemy who is helpless. If you want a picture of the future, imagine a boot stamping on a human face — forever." I never thought they would win, I always thought that at the end of the day the rule of law would prevail. Yes, the rule of man's law. Instead power prevailed, so many rules broken by the system to break me. It took years, but, finally, the end that Dr Bowman predicted is upon me, the end that she advised the BLE to take to break me. Ironically, that is the one thing in her far left of center report that the BLE (after stamping, in red ink, on Jan 22) is uninterested in, as that the BLE and ADA office that used the federal statute as a sword now refuses to even dialogue on her dire prediction as to my fate. "C'est la vie" Entertaining enough for you, status quo defender?

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