The Indiana legislature appears on course to enact measures that would protect health insurance-holders from being charged out-of-network rates for services they receive at an in-network medical facility. Proposals are also moving along to set up something called an “all-payer claims database” that would allow prospective patients to see how much various hospitals charge for the same procedures.
But while we all can applaud efforts to help patients reduce health care costs, we should also be paying careful attention to national efforts to reduce Medicaid benefits.
This could have a powerful impact on Indiana. About one in five Hoosiers is enrolled in HIP 2.0 or some other Medicaid-funded Indiana health coverage program. Hospitals, nursing homes and thousands of health care workers depend on Medicaid funding to serve those 1.4 million people. And all of us live in a state whose enormous health challenges could only be magnified if coverage for some of those now protected by Medicaid is reduced or eliminated.
Last month, the Trump administration announced plans to allow states to switch to block-grant funding for some Medicaid programs that now give states whatever funds they need to cover all those who need assistance.
Conservatives who have pushed block-grants – Vice President Mike Pence argued for them when he was Indiana governor – say they want to give states more control over the health-coverage programs they run. But health advocates warn that states that choose the block-grant plan could be forced to limit benefits or reduce recipients during times when more people might qualify for coverage.
The Indianapolis Business Journal recently asked Gov. Eric Holcomb and officials with the Indiana Family and Social Services Administration whether the state might ask to be switched to Medicaid block grants. Both Holcomb's office and the FSSA, which administers Medicaid in the state, declined to comment.
Paul Halverson, dean of the Fairbanks School of Public Health at IUPUI, told the Business Journal he had not seen the details of the Trump administration's plan. But he said, “I fear the block-grant programs could put our most vulnerable people at increased risk,” and noted, “block grants can invariably lead to arbitrary limits on eligibility and coverage.”
Meanwhile, the president has sent a budget to Congress that calls for cuts in both Medicaid and Medicare funding. And a lawsuit challenging the Affordable Care Act filed by a group of Republican state attorneys general – including Indiana's Curtis Hill – remains active. By sending the matter back to a lower court, an appeals court ensured that the matter won't be settled before this fall's election. But if the Affordable Care Act or parts of it were struck down, Medicaid-expansion programs such as HIP 2.0 could be endangered.
Achieving greater transparency in health care costs and preventing “surprise” bills from out-of-network providers are great issues for Holcomb and the legislature to tackle. But Hoosiers should also be paying close attention to the future of Medicaid and how the national efforts to undercut this half-century-old federal program will be addressed in Indiana.