Newsflash:
Rob Zerban IN Medicaid Expansion Another conservative governor finds a way to expand Medicaid
Friday, 16 May 2014 16:14

Another conservative governor finds a way to expand Medicaid

Written by  Jason Millman | The Washington Post
Rate this item
(0 votes)

It looks as if Indiana is about to join the list of red states signing up for Obamacare's Medicaid expansion.

Republican Gov. Mike Pence, after months of discussions with the Obama administration, is offering a new plan Thursday morning to expand coverage to low-income uninsured Hoosiers. As expected, he's doing it through an existing state insurance program for adults that's been championed by some conservatives.

About two dozen states still haven't joined the Affordable Care Act Medicaid expansion, which extends coverage to low-income adults earning up to 138 percent of the federal poverty level. Some states like Texas and Louisiana seem pretty entrenched in their opposition to major elements of Obamacare. Other red states, however, are still looking for alternative ways to accept hundreds of millions, and even billions, in federal dollars to expand coverage — all while trying to maintain some rhetorical and policy distance from the Medicaid expansion envisioned by the ACA.

The White House is pushing reluctant states to expand Medicaid to close an unintentional coverage gap created by the Supreme Court's 2012 decision on the health-care law. Among the states that haven't expanded, there are about 5 million poor adults who don't earn enough to qualify for federal subsidies on the Obamacare health insurance marketplaces.

Indiana's unique situation

First, some background on Indiana. Pence last year insisted that he would only expand coverage if he could do it through the Healthy Indiana Plan, a health savings account-type of program for about 45,000 adult Hoosiers who didn’t qualify for the traditional Medicaid program.

The Obama administration maintained that Indiana couldn’t expand Medicaid through HIP because the program had an enrollment cap, and some cost-sharing features may have been problematic. HIP's design has been praised by conservatives for requiring Medicaid beneficiaries to be more conscious consumers because they take more financial responsibility for their care.

It looked like HIP was at risk of expiring in 2013, but the federal Centers for Medicare and Medicaid Services and Indiana struck a deal last September to keep the program running through the end of this year. It gave both sides more time to negotiate on the Medicaid expansion, and it allowed people enrolled in HIP to keep their coverage in the meantime.

The Pence proposal

Pence will lift HIP enrollment caps, opening up the program to working-age adults earning less than 138 percent of the federal poverty level ($16,105 for an individual or $32,913 for a family of four). Between 334,000 and 598,000 people will be covered under the plan, according to Pence's office. Enrollment will open in 2015, with federal approval.

The existing HIP program, which only covered people under the federal poverty level, required enrollees to contribute to the first $1,100 of their care. Under the expanded program, there will be two levels of coverage.

  • HIP Members under the poverty level have the option to make monthly contributions. If they don't, they'll be transferred to a more basic level of coverage without vision and dental benefits. The lower coverage level requires co-payments for services, instead of monthly premiums. There are no co-pays, though, for preventive care and family planning services.
  • HIP members above the poverty level who don't pay a monthly contribution within 60 days are locked out of the program for six months. They can't opt into the basic coverage level.

Here's what those monthly contributions would be, which are all up slightly from the current program:

(Office of Governor Mike Pence)

(Office of Governor Mike Pence)

The HIP deductible is increasing from $1,100 to $2,500, but Indiana is covering those extra costs. By comparison, the average deductible for a mid-level "silver" plan under the ACA is slightly higher than HIP's, at $2,907, according to to HealthPocket. And while Obamacare opponents have criticized high-deductible individual plans under the health-care law, Pence says the HIP high-deductible plans are an intentional design feature.

"Exposure to and awareness of the cost of care are key components of the consumer-directed model that encourages price and quality transparency from providers," according to a document Pence's office. "The increased deductible aligns with private market high deductible health plans paired with a health savings account, providing members valuable experience with a private market plan design."

Starting in 2016, Indiana will offer a new employer-based option. Those eligible for HIP can choose to enroll in the state program, or they can opt for a state contribution to help with the cost of employer-sponsored insurance. The choice is theirs.

What happens now

Pence is seeking a five-year waiver from the feds to operate the program, with the state pitching in $1.5 billion from an existing cigarette tax and hospital fee. Indiana will have to hold public hearings and take public comment on the plan before submitting a final waiver proposal to CMS sometime in late June. From there, Indiana and the feds will negotiate on the plan's finer points.

“We are encouraged by Indiana and Governor Pence’s commitment to helping cover more of the state’s uninsured population through the Healthy Indiana program and look forward to seeing his proposal," said CMS spokeswoman Emma Sandoe in a statement.

Pence's proposal comes as CMS is weighing plans from two other Republican governors to cover low-income adults with Medicaid expansion dollars through alternative approaches. Pennsylvania Gov. Tom Corbett's plan has been met with skepticism from Democrats and Obamacare advocates, while Gov. Utah Gov. Gary Herbert continues to negotiate with CMS. His biggest challenge, however, may come from reluctant Republican state lawmakers back home.

Ultimately, the Obama administration wants all the states to expand their Medicaid programs. As Indiana's new plan shows, that's going to take some creative maneuvering in Republican states.

Link to original article from The Washington Post

Read 1089 times

ERA Legislation in your State

Unratified states Gold - Ratified States Purple

Latest News from the Zerban Campaign

  • Meet the Man Who's Trying to Force Paul Ryan to Look for a Real Job
    Meet the Man Who's Trying to Force Paul Ryan to Look for a Real Job

    Once again, Koch brothers cash will face off against a people-powered campaign in Wisconsin this November. The race is for a House seat in the first Congressional District, a seat now held by Paul Ryan. His challenger – the first serious challenge he's faced in 14 years in Congress – is Rob Zerban, a restaurateur and County Commissioner.

    Written on Sunday, 02 September 2012 17:49 Read more...
  • The Real Cost of the Ryan Budget
    The Real Cost of the Ryan Budget

    Everywhere I go during my campaign — parades, farmers markets, even the local deli — I keep hearing the same thing from Wisconsin voters. “We need real representation,” they tell me, “representation that’s focused on the people and what we need.”

    Written on Thursday, 09 August 2012 19:51 Read more...
  • Zerban Submits 230% of Required Nomination Signatures Today
    Zerban Submits 230% of Required Nomination Signatures Today

    "The message is clear: Paul Ryan must be held accountable for his 14 years of failed decisions"

    Written on Saturday, 02 June 2012 01:34 Read more...
  • A Man Who Looks Paul Ryan's Storm Dead in the Eye
    A Man Who Looks Paul Ryan's Storm Dead in the Eye

    "He had a minor in economics," Rob Zerban says of his opponent. "What experience does he have to say that he's the great budget oracle?" "The people of the First District can see where that budget impacts their lives. Their bridges start to crumble. We've got 16 bridges on federal highways alone in the district that have been declared structurally deficientm and that doesn't include county and local municipal bridges.

    Written on Friday, 27 April 2012 01:52 Read more...
  • Rob Zerban Has My Vote in 2012
    Rob Zerban Has My Vote in 2012

    Typically during an election cycle, it often comes down to voting for the lesser of two evils. You choose the one who supports the issues most meaningful to you – or at least doesn’t outright defy them. It can be difficult to encounter a candidate who personifies the conviction and integrity you would imagine only in a perfect political world.

    Written on Sunday, 15 April 2012 18:11 Read more...
  • Rob Zerban Statement on Paul Ryan’s FY2013 “Path to Poverty”
    Rob Zerban Statement on Paul Ryan’s FY2013 “Path to Poverty”

    Today, Rob Zerban, Democratic Congressional challenger to Congressman Paul Ryan, released the following statement in response to the introduction of Paul Ryan’s FY2013 “Path to Poverty” budget.

    “In yet another misguided handout to Wall Street at the expense of Main Street, Congressman Paul Ryan today introduced his latest budget plan, designed to place the blame for his 14 years of poor decisions squarely on the backs of our hardworking families.

    Written on Sunday, 15 April 2012 18:07 Read more...
  • WI-01 Rob Zerban Campaign Kickoff Tour Highlights
    WI-01 Rob Zerban Campaign Kickoff Tour Highlights

    When I began this campaign, I made a commitment to serve as a voice of the people- not of corporations.

    I have been putting that into action. In the last few weeks, I have been working overtime to kickoff my campaign with rallies across the district.

    Written on Monday, 12 March 2012 00:00 Read more...
  • John Nichols: How Rob Zerban forced Paul Ryan to defend Internet freedom

    The American Civil Liberties Union, Free Press and the Save the Internet campaign have made it clear that the Stop Online Piracy Act poses a genuine threat to human rights advocacy and whistleblowing on the Web.

    Written on Tuesday, 17 January 2012 00:00 Read more...

Sign the Petition - Sen. Sanders Run as a Democrat in 2016

Button-SandersPetition

Lori Wallach on the TPP from PDA Progressive Roundtable

Progressive Roundtable with Reps. Ellison and Pocan and Lori Wallach on TPP

TPP: The Biggest Threat to the Internet You've Probably Never Heard Of