Most discussion of the Affordable Care Act to this point has focused on the controversial health-care exchanges, state-based systems through which individuals earning between 133 percent and 400 percent of the federal poverty level can obtain coverage. At issue now is expansion of Medicaid, to provide care not only for pregnant women, children and people with disabilities but also for the working poor.
Q: Why is Medicaid expansion an issue?
A: Last year’s Supreme Court decision upheld the federal health-care act and the proposed exchanges but also ruled that the federal government could not force states to expand Medicaid coverage to cover those too poor to qualify for tax credits to buy coverage in a health insurance exchange.
Q: How many Indiana residents are affected?
A: Nearly 407,000 Hoosiers. A gap exists between the current Medicaid program, which covers mostly pregnant women and children, and the health insurance exchanges.
Q: What will it cost to provide coverage?
A: It depends on who is supplying the estimate. Milliman Inc., which did a study for the Republican-controlled state government, says it would cost more than $2 billion. A University of Nebraska Medical Center report says it would be much less – $503 million.
Q: How would Indiana pay for new Medicaid enrollees?
A: As an incentive to expand coverage, the federal government will cover 100 percent of the expansion through 2016, which will decline each year to reach 90 percent by 2020 – an estimated $10.5 billion over seven years. Nearly half the states have decided to expand coverage, including several led by GOP governors who oppose the federal program.
A: Gov. Mike Pence and other Republican officials oppose the federal health care program on political and philosophical grounds. They want to expand Indiana’s Healthy Indiana Program, which covers just 40,000 Hoosiers, because they believe it is better administered.
Q: Can the HIP program be expanded?
A: Yes, but it will require approval from the federal government and will fundamentally change the program by expanding it tenfold.