Maureen Groppe, writing for Gannett, has a story entitled “Report: Big Drop in Uninsured if Indiana Expands Medicaid.”
To recap, part of the healthcare reform effort was to expand Medicaid eligibility for people up to 138% of the poverty level (that’s roughly $27,000 for a family of three according to the news article). Originally, the expansion was more or less mandatory; but the Supreme Court said it had to be discretionary, state by state. Gov. Pence never liked the idea of health care reform and, one gets the sense that his opposition is as much political as it is policy-driven. And, so, Indiana is exercising its discretion not to expand Medicaid. Instead, as a fig leaf of sorts, Indiana is attempting to have the feds endorse the state’s Healthy Indiana plan as a Medicaid expansion substitute.
“Gov. Pence has made clear to Secretary Sebelius that any discussion on a potential coverage increase must start with the Healthy Indiana Plan,” Pence spokeswoman Kara Brooks said Wednesday. “As our current waiver expires at the end of this year, the first priority is to secure an extension of the current program.”
(“Must” — the feds love it when you try to dictate terms to them.) In any event the Healthy Indiana plan covers 37,000 with 53,000 on a waiting list. The Medicaid expansion, funded mostly by the federal government, would insure 400,000. According to the Kaiser Commission report cited by Ms. Groppe, the number of uninsured Hoosiers would be cut in half; reducing the state’s non-elderly, uninsured population from 17% to 8%.
Also, according to Aaron Carroll, aside from not covering as many people, the Healthy Indiana plan costs Indiana more than Medicaid expansion would. A lot more:
Indiana will save a lot of money by allowing the expansion to occur. In 2009, it’s estimated that we spent more than $150 million on the Healthy Indiana Plan. This would no longer be needed, as many would transition into either the Medicaid expansion or the private insurance exchanges. We spent $15 million on our high risk pool plan, which would no longer be needed, as those people would get insurance elsewhere, too. We spent more than $12 million on local tax credits for businesses buying insurance which would no longer be needed as they are replaced by federal tax credits. We spent more than $125 million on uncompensated care for the indigent which would no longer be needed, as far fewer people would be uninsured. And, finally, there was a hidden tax of almost $30 million put on Hoosiers to pay for uninsured care for others through cost shifting and higher premiums. This, too, would go away. We may even be able to save more money if we petition HHS to allow us to transition some children and families from CHIP to the exchanges. But even without that, if you add all the spending I just laid out together, Indiana could have saved more than $335 million in 2009 alone, compared to the $63 million the expansion would have cost if Indiana had covered 10% that year. The savings would more than pay for the costs of the expansion moving forward.
Let’s get back to basics. The rest of the industrialized world has figured this out. They provide health care to their people; they do it for less money; and they get similar if not better outcomes. We could do this too if we wanted to; we’re just reluctant to do so.