Now that the healthcare reform law has been upheld, I think there are at least two areas where the states (including Indiana) have to take action.
One area is Medicaid expansion. As written, I think the law basically forced states into expanding their Medicaid program. It penalized states for not expanding their Medicaid programs by gutting (eliminating?) federal funding for their existing programs. One majority of the court held that this penalty was unconstitutionally coercive. A separate majority of the court held that the remedy for this unconstitutional coercion was, basically, to read it out of the statute. So, states don’t put their existing Medicaid programs at risk by declining to adopt the expansion.
The expansion itself provides for Medicaid coverage to individuals with income 133% of the poverty line or below. This is up from something like 65% currently along with a requirement that you meet one of the eligibility categories. (Broadly speaking – there are nuances.) The federal government would pay all of the expansion expenses for the first few years and then requiring the states to contribute incrementally more, up to 10% of the costs in 2020 and thereafter. Now states have to decide whether they want to take the 90% federal government match or not. From a pure state cost/benefit perspective, it’s tough to walk away. But, from a political perspective, I imagine that a lot of red states will turn away the federal money at the expense of their poorer citizens.
The other major state action I know about has to do with healthcare exchanges. I’m going from an explanation from an acquaintance whose opinion I trust. What the law mandates, as I understand it, is that each state (or group of states) create an insurance exchange. If they don’t, the federal government will do it for them. Each exchange must have at least two insurance companies competing in it, of which one must be a not for profit. If not, the federal government will create a not-for-profit mutual insurance company. Inaction will, therefore, lead to federal interference.