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Associated Press
Montana Gov. Steve Bullock speaks at a Medicaid expansion rally last month in Helena. Indiana would lose billions of federal dollars if officials don’t reach a deal with the federal government on treating more insured working poor.

Medicaid growth a plus

Before it adjourns this month, the General Assembly faces a task on par with its biennial budget in terms of importance: What to do about expanding coverage for the uninsured?

Morally, it’s an easy call. More than 800,000 Hoosiers younger than 65 have no health insurance coverage.

Financially, there should be no hesitation to do so. A study by the University of Nebraska Medical Center estimates Indiana would see $3.4 billion in new economic activity by expanding coverage under the Affordable Care Act.

Gov. Mike Pence continues to stand strong in opposition to Medicaid expansion. But the decision is not his alone to make. Lawmakers’ best course is to position Indiana to negotiate with the federal government in providing health care for more than 400,000 residents who now fall in the gap between those eligible for Medicaid coverage under the state’s current guidelines and the 400,000 who will be eligible to participate in the health insurance exchanges.

Efforts pushed by the House Public Health Committee under Chairman Ed Clere, R-New Albany, would require Indiana to seek a middle ground between the Affordable Care Act and the Healthy Indiana Plan, which Pence wants to use. Clere’s plan includes an escape clause if the federal government doesn’t keep its spending commitment.

The issue doesn’t affect just the uninsured. The new study, commissioned by the Indiana Hospital Association, projects that a reduction in the number of uninsured Hoosiers would drive down the cost for Hoosiers with insurance. Individuals could save an average $236 a year; families would save $677.

Local health officials point to the benefit of reduced health-care spending overall, as well as a regional economic benefit.

“What we see are a lot of (uninsured) people who have delayed care,” said Joe Dorko, CEO for Lutheran Health Network. “It’s much easier to treat hypertension than to put someone through open heart surgery.”

Dorko said hospitals currently must shift the cost of uncompensated care to commercial insurers, which is why health-insurance premiums are rising. Lutheran’s cost for uncompensated care in 2011 was $147 million.

Michael Packnett, president and CEO of Parkview Health, said the proposed expansion will cover about 45,000 people in the 10-county northeast Indiana region, with an estimated economic impact of $70 million to $90 million in Allen County alone over the next seven years. The expansion will sustain an estimated 3,000 jobs in the region and could create nearly 200 more.

“I hope we don’t miss the chance to do this,” Packnett said.

The Centers for Medicare and Medicaid Services would have to approve Indiana’s use of the Healthy Indiana Plan for Medicaid expansion, lifting the current cap of 40,000. HIP would also have to broaden its coverage to meet ACA requirements. But the go-ahead for an expansion plan in Arkansas suggests federal officials might support it.

Indiana lawmakers have a tough job ahead approving a two-year budget; a decision to expand Medicaid coverage to 400,000 Hoosiers is an easy call and the right one to make.