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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. So that none are misinformed by my posting wihtout a non de plume here, please allow me to state that I am NOT an Indiana licensed attorney, although I am an Indiana resident approved to practice law and represent clients in Indiana's fed court of Nth Dist and before the 7th circuit. I remain licensed in KS, since 1996, no discipline. This must be clarified since the IN court records will reveal that I did sit for and pass the Indiana bar last February. Yet be not confused by the fact that I was so allowed to be tested .... I am not, to be clear in the service of my duty to be absolutely candid about this, I AM NOT a member of the Indiana bar, and might never be so licensed given my unrepented from errors of thought documented in this opinion, at fn2, which likely supports Mr Smith's initial post in this thread: http://caselaw.findlaw.com/us-7th-circuit/1592921.html

  2. When I served the State of Kansas as Deputy AG over Consumer Protection & Antitrust for four years, supervising 20 special agents and assistant attorneys general (back before the IBLE denied me the right to practice law in Indiana for not having the right stuff and pretty much crushed my legal career) we had a saying around the office: Resist the lure of the ring!!! It was a take off on Tolkiem, the idea that absolute power (I signed investigative subpoenas as a judge would in many other contexts, no need to show probable cause)could corrupt absolutely. We feared that we would overreach constitutional limits if not reminded, over and over, to be mindful to not do so. Our approach in so challenging one another was Madisonian, as the following quotes from the Father of our Constitution reveal: The essence of Government is power; and power, lodged as it must be in human hands, will ever be liable to abuse. We are right to take alarm at the first experiment upon our liberties. I believe there are more instances of the abridgement of freedom of the people by gradual and silent encroachments by those in power than by violent and sudden usurpations. Liberty may be endangered by the abuse of liberty, but also by the abuse of power. All men having power ought to be mistrusted. -- James Madison, Federalist Papers and other sources: http://www.constitution.org/jm/jm_quotes.htm RESIST THE LURE OF THE RING ALL YE WITH POLITICAL OR JUDICIAL POWER!

  3. My dear Mr Smith, I respect your opinions and much enjoy your posts here. We do differ on our view of the benefits and viability of the American Experiment in Ordered Liberty. While I do agree that it could be better, and that your points in criticism are well taken, Utopia does indeed mean nowhere. I think Madison, Jefferson, Adams and company got it about as good as it gets in a fallen post-Enlightenment social order. That said, a constitution only protects the citizens if it is followed. We currently have a bevy of public officials and judicial agents who believe that their subjectivism, their personal ideology, their elitist fears and concerns and cause celebs trump the constitutions of our forefathers. This is most troubling. More to follow in the next post on that subject.

  4. Yep I am not Bryan Brown. Bryan you appear to be a bigger believer in the Constitution than I am. Were I still a big believer then I might be using my real name like you. Personally, I am no longer a fan of secularism. I favor the confessional state. In religious mattes, it seems to me that social diversity is chaos and conflict, while uniformity is order and peace.... secularism has been imposed by America on other nations now by force and that has not exactly worked out very well.... I think the American historical experiment with disestablishmentarianism is withering on the vine before our eyes..... Since I do not know if that is OK for an officially licensed lawyer to say, I keep the nom de plume.

  5. I am compelled to announce that I am not posting under any Smith monikers here. That said, the post below does have a certain ring to it that sounds familiar to me: http://www.catholicnewworld.com/cnwonline/2014/0907/cardinal.aspx

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