Opinion and Taking Issue

KENNEDY: Not healthy, wealthy or wise

January 11, 2014

Sheila Suess KennedyMany of us have just wished our friends and loved ones a healthy, happy and prosperous new year. In Indiana, those are going to be elusive goals.

According to a report issued in December by the respected Kaiser Family Foundation, Indiana stands to forgo $17.3 billion between 2013 and 2022 because we refuse to follow the lead of surrounding states (including those governed by Republicans) in implementing the ACA’s Medicaid expansion.

Indiana is refusing to accept the federal dollars that would pay for the expansion of Medicaid despite the fact that over half a million Hoosiers have lost employer-sponsored coverage since 2000, and despite the fact that Indiana has seen the nation’s largest loss of health insurance coverage for children. More than 18 percent of Indiana children have lost coverage since 2000.

Let’s talk dollars and sense.

Under the ACA, the federal government will pay 100 percent of the costs of expanded Medicaid for the first three years and 90 percent thereafter. Expansion would actually save Hoosier taxpayers money, since some of those federal dollars would pay for services we currently provide.

Since there is no rational reason to forgo billions of dollars and deny a quarter of a million Hoosiers access to affordable coverage, some Indiana officeholders have resorted to deliberately misleading their constituents.

One legislator recently sent out a survey seeking “input on legislative topics.” The Medicaid question read as follows:

“Currently, one out of six Indiana residents is on Medicaid, or about 1.1 million Hoosiers. Medicaid makes up about 14 percent of the state’s budget. Under the Affordable Care Act [or Obamacare], Indiana can expand Medicaid to cover more uninsured Hoosiers at a projected cost to taxpayers of more than $1.4 billion by 2020. This expansion would allow one in four Indiana residents to enroll in the program. Do you support full Medicaid expansion for Indiana under Obamacare guidelines?”

The question clearly implies that Indiana taxpayers would foot the bill for expansion. (Of course, he might get an answer he doesn’t want if he explained that federal dollars would cover the costs.)

The question we need to ask our senators and representatives is pretty simple: Why are you refusing to allow the federal government to pay the entire cost of expanded coverage for three years and 90 percent thereafter—especially when those dollars you are rejecting would create an estimated 30,000 Hoosier jobs and—according to health economists—would reduce premiums paid by those of us who do have private insurance?

The only response I’ve heard is highly speculative: The federal government might stop paying the full 90 percent at some future time. But if the feds cut payments, we could cut services.

It’s hard to escape the conclusion that Indiana is leaving $17 billion on the table, leaving more of our citizens uninsured, costing Hoosiers who are insured more money, and refusing to cover Indiana’s most vulnerable children simply because our governor and state legislative leaders will oppose anything and everything proposed by this president, no matter how that opposition affects the citizens they were elected to serve.

That petty, partisan motivation will cost everyone who lives in Indiana. Thanks to the governor’s refusal to implement the ACA’s Medicaid expansion, Hoosiers will pay higher state taxes, higher health insurance premiums and higher out-of-pocket expenses. And those costs will fall most heavily on those who can least afford them.

Our politicians might be aiming at President Obama, but the people they are hurting are the Hoosiers who elected them.•

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Kennedy is a professor of law and public policy at the School of Public and Environmental Affairs at IUPUI. She blogs regularly at www.sheilakennedy.net. She can be reached at skennedy@ibj.com. Send comments on this column to ibjedit@ibj.com.

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