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Time to join Medicaid expansion

Gov. Mike Pence made it crystal clear this month he will not permit the state to expand Medicaid eligibility under the Affordable Care Act. But Florida Gov. Rick Scott said the same thing – until he reversed position last week.

If Scott, a former health care executive, has concluded that he can’t in good conscience deny his constituents access to care that expansion would bring, it’s time for Pence and the GOP-controlled Indiana legislature to follow suit. Across the nation, the roll of Republican officials who have reversed course to support Medicaid expansion grows, and for good reason.

Aaron Carroll, associate professor of pediatrics and the associate director of Children’s Health Services Research at Indiana University School of Medicine, offered compelling testimony before Indiana’s House Public Health Committee earlier this month.

“The Medicaid expansion is a hugely cost-effective way for Indiana to cover its citizens. In models that assume participation in the expansion will mirror current Medicaid usage, the vast majority of the cost of the expansion is paid for by the federal government,” said Carroll, also director of the Center for Health Policy and Professionalism Research. “If we managed to cover about 300,000 new people by Medicaid through 2019, it would cost us only $478 million over those years, versus $8.5 billion from the federal government. While Medicaid enrollment would go up by more than 29 percent, our state Medicaid spending will have gone up by only 2.5 percent. That’s an almost unheard-of deal.”

Carroll argues that Indiana will save money under the expansion. There’s the $150 million a year no longer needed for the Healthy Indiana Plan or the $15 million for the high-risk pool plan. Another $12 million spent on local tax credits for businesses buying insurance would no longer be needed, replaced by federal tax credits. Then there is the more than $125 million on uncompensated care for the indigent, as far fewer people would be uninsured.

“And, finally, there was a hidden tax of almost $30 million put on Hoosiers to pay for uninsured care for others through cost shifting and higher premiums. This, too, would go away,” Carroll testified. “If you add all the spending, … Indiana could have saved more than $335 million in 2009 alone, compared to the $63 million the expansion would have cost if Indiana had covered 10 percent that year.”

Pence, in communication with Health and Human Services Secretary Kathleen Sebelius, instead has asked that Indiana be permitted to use the Healthy Indiana Program to serve an expanded Medicaid population.

Pence said the federal program is “rife with waste and fraud.” Indiana’s plan has a 98 percent approval rating from participants, and it encourages wellness and healthy behavior.

The Healthy Indiana Program may, indeed, be promising, but it’s too little, too late. It covers just 40,000 Hoosiers, with 46,000 more on the waiting list. The pool of Indiana residents eligible for coverage under the federal Medicaid expansion – up to 138 percent of the poverty line – is 400,000, most of them working-class Hoosiers whose employers don’t provide health care coverage or offer insufficient policies.

As IU’s Carroll notes, the decision is not between giving vulnerable residents a choice between Medicaid and private health insurance – it’s between giving them Medicaid and nothing.

In good conscience, as the Florida governor concluded, how can Pence and Republican legislators deny those Hoosiers needed access to care?