Indiana Gov. Mitch Daniels' team of federal health care overhaul leaders told state lawmakers Wednesday that even without clear answers on the new law, it will cost the state hundreds of millions more in the coming years.
A new report this week assumed that if Medicaid isn't expanded, Indiana would still pay a combined $612 million over the next seven years as more residents who qualify for the program come out of the "woodwork" because of the health care law. Milliman, an actuary, is assessing the potential costs for the state.
Daniels has left two key decisions to whoever succeeds him — whether the state should establish its own insurance exchange and whether it should expand Medicaid coverage. Republican Mike Pence has not said what he would do, aside from continuing to oppose the health care law. Democrat John Gregg and Libertarian Rupert Boneham have said the state should run a "hybrid" exchange in coordination with the federal government.
Beyond those questions, however, state health overhaul consultant Seema Verma told members of the General Assembly the state is having trouble getting answers from the Obama administration on specifics of the new health care law.
"I do think that it's a huge challenge. There are so many unanswered questions," she said. "They haven't told us how much it's going to cost. I think it put states in very difficult positions."
Indiana health care advocates say, however, that many other states are moving forward with exchanges and seem to be having little trouble coordinating with the federal government.
"There are a bunch of other states that certainly would disagree with Seema that there's not enough information for them to make a decision and they're moving ahead on it," said David Roos, executive director of Covering Kids and Families of Indiana.
Verma also said the state would accept a one-year expansion of its health savings account plan, the Healthy Indiana Plan. The Centers for Medicare and Medicaid Services approved the state for an expansion at the end of July, but the Daniels' administration griped about not getting a requested five-year expansion or an answer whether the plan could serve as an expansion of Medicaid.
The state has until Oct. 1 to say which benefits would be covered in a state exchange and until Nov. 16 to decide whether to run an exchange.
The winner of the governor's race will have until 2014 to decide whether the state should expand Medicaid coverage.