Opinion and Forefront

SIDDIQUI: Forward with the Medicaid experiment

June 1, 2013

SiddiquiGov. Mike Pence’s proposed expansion of health care for low-income Hoosiers through the Healthy Indiana Plan is a valuable experiment that will continue Indiana’s trend as an innovator in government.

Critics attacked the Legislature’s failure to force Pence to expand Medicaid for an estimated 400,000 indigent and low-income Hoosiers, arguing the move will cost employers money, increase costs for hospitals and health care providers required to provide indigent care, and hurt Indiana’s economy while leaving the 400,000 Hoosiers to the mercy of a costly emergency room as their only health care option.

However, these arguments don’t take into consideration the advantage of experimenting with an additional method of Medicaid expansion.

Experts on all sides argue that Medicaid expansion in any form has unforeseen consequences, but simply pushing for a uniform expansion of low-income health care fails to take advantage of the Founding Fathers’ vision of different states serving as micro labs of democracy that could help our nation over time.

This idea has served us well. Those who support the Affordable Care Act acknowledge the advantages of having Massachusetts test health care expansion before the nation adopted the model nationally.

Indeed, U.S. Supreme Court Justice Louis Brandeis said that a “state may, if its citizens choose, serve as a laboratory, and try novel social and economic experiments without risk to the rest of the country.”

Indiana’s option for health care expansion may not be what was envisioned by those who enacted the law, but it is what Hoosiers have affirmed as the way forward.

Additionally, Pence was clear that he would oppose Medicaid expansion and establish a health care exchange. His opposition throughout this legislative session simply affirmed his campaign promises.

Trying to cover more low-income Hoosiers through the Healthy Indiana Plan helps Indiana continue its trend of leading in government innovation. Government innovation has built roads and created jobs; why not try expanding health care?

Established in 2007 by Gov. Mitch Daniels, the Healthy Indiana Plan covers adults ages 19 to 64. It requires low-income Hoosiers to pay 2 percent to 5 percent of their gross family income toward the plan, and provides coverage regardless of pre-existing conditions.

The Indiana Hospital Association, which has favored expansion, has argued that this plan will reduce pressure on emergency rooms for indigent care.

Critics have argued that requiring Hoosiers to contribute a percentage of their income will deter enrollment into the plan. However, the Healthy Indiana Plan has a wait list due to lack of state funds beyond the initial 40,000 enrolled.

Furthermore, the same criticisms were made against Wishard Health’s charging small fees to raise revenue through its Wishard Advantage program. Wishard Advantage remains popular and has increased over time.

Both sides of the debate seek to provide more Hoosiers access to health care. They have a “healthy” disagreement over how we can achieve this goal. The Affordable Care Act has one prescription, Arkansas’ premium support program suggests another, and Indiana now offers a third option.

Only time will tell which of these options will best serve our country.

It is now time for all Hoosiers to push for more Hoosiers to have access to health care.•

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Siddiqui is an attorney and doctoral student at Lilly Family School of Philanthropy at Indiana University, and publisher of Siddiqui Public Affairs Review. Send comments on this column to ibjedit@ibj.com.

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