Pence asks to meet with Sebelius over HIP expansion

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Gov. Mike Pence has requested a meeting with U.S. Health and Human Services Secretary Kathleen Sebelius “to work through any outstanding issues that stand in the way” of Indiana expanding Medicaid coverage via its Healthy Indiana Plan.

Pence requested the meeting in a letter dated Nov. 15, which was made public by Pence’s office on Tuesday.

Pence has so far declined to expand eligibility for the Medicaid health program for the poor, as called for in President Obama’s health reform law. That law, known as the Affordable Care Act, called for all states to make Medicaid available to all adults making up to 138 percent of the federal poverty limit—but the U.S. Supreme Court ruled that states can decline to expand Medicaid coverage.

Such an increase is projected to add 182,000 Hoosiers to the Medicaid program, according to the California-based Kaiser Family Foundation.

Instead, Pence wants to expand Medicaid coverage using some form of the Healthy Indiana Plan, which currently provides insurance to about 40,000 Hoosiers who agree to make monthly contributions to health savings accounts.

Pence acknowledged that the monthly contributions have been an issue in discussions with Sebelius’ agency, but he insisted on some form of consumer responsibility in any expansion of coverage in Indiana.

“However, in order to expand the Healthy Indiana Plan, it is essential that the State be able to maintain the consumer-driven model on which the program is predicated,” Pence wrote.

The Obama administration did agree to keep the consumer contributions in the Healthy Indiana Plan when it renewed the plan in August. Indiana was also allowed to keep a cap on enrollment, based on available funding.

Both features are different than the traditional Medicaid program, which covers all of a patient’s expenses and has no limit on enrollment. But those features have driven the cost of Medicaid steadily higher for Indiana, with the state projecting it will grow rapidly even without an expansion of the program.

The state is currently spending $2.7 billion, or about 18 percent of its annual budget, to cover about 1 million Medicaid participants. According to 2012 estimates by the actuarial firm Milliman Inc., the state’s Medicaid expenses will grow by another $1 billion per year by 2020—even without an expansion.

The Obama administration has “challenged” the Pence administration to come up with new ideas for solving those two issues before agreeing to expand the program, said Deb Minott, Pence’s secretary of the Indiana Family and Social Services Agency, which administers Medicaid in Indiana.

“They’re really trying to challenge us to come up with other ways of doing that,” Minott said in a Nov. 1 interview. And so, she added, state officials are “brainstorming” ways of preserving HIP’s principals of individual and fiscal responsibility, while satisfying the concerns of the Obama administration.

But in his letter, Pence again defended those key provisions of the Healthy Indiana Plan.

“Unlike traditional Medicaid, the Healthy Indiana Plan gives its members ‘skin in the game’ with regard to their healthcare and lifestyle decisions,” Pence wrote. “As a result, Healthy Indiana Plan members utilize preventive care services more often and the emergency room less often than traditional Medicaid members. … Our actuaries predict that, over time, healthcare costs are lower under this model.”

The Healthy Indiana Plan was created by Gov. Mitch Daniels in 2007 and passed with bipartisan support in the state Legislature. It is funded by a tax on cigarettes.


  • fraud/deception
    I was first to say hey to the hip program when it came out. As time surely went by I only discovered that there is no way you will ever be entered into the program because it has great problems as well. The administration does not want to expand the traditional medicaid program because they really dont want to clean up their own mess they have created by not having the proper watchdogs in place thus creating indiana medicaid fraud to its victims namely we the people. How sad many of us hoosiers will ultimately die still trying to get the healthcare. Coverage we so greatly have been promised by our elected dirty hands at work.God Bless you all
    I applied for hip for my 19 and 21 year back in December 2012...who are in college and can barely afford food and gas to get to school. And they both work part time jobs. They qualify for it. But were denied because it was full. I called and was told to reapply one month and 4 days later. Rather than deal with the original case number. reapplying would create a new one. And mountain of new paperwork for state employees. POORLY RUN. Hip does not ever pull people off a so called waiting list at all. you have to reapply. So people who sit and wait will never get insurance. Indiana is one of the few states that does this. SHAME ON INDIANA. AND THEIR LOGO THAT SAYS 'INDIANA..A STATE THAT WORKS'. What a joke! Indiana is a broken state with state employees who do not do their job. Pitiful...just plain pitiful!
  • depriving health care = murder
    If Pence and his clowns don't have all of their ducks in a roll with this discriminatory HIP privilege club, I hope they get caught and charge with 2nd degree murder for all those who where rejected that died because they couldn't afford health care.
  • Thanks Linda and Sally
    Thanks to you both for your comments. They are both right on the money and highlight the reality of HIP coverage in Indiana. It is a sham. My stepdaughter has been on the waiting list for 2 years. Fortunately, she will be able to get health insurance under the ACA. The word "evil" comes to mind when I read the statements coming out of the Pence administration talking about "personal responsibility" and "consumer driven." Do they really believe this stuff?
  • Pence and the Tea Party
    Thank you Pence and the tea party for making it impossible for those of us who have worked for decades and paid taxes to provide Medicare, Medicaid, and health insurance to government employees. I've been unemployed for more than 2 years and am in my mid-50's. I'm one of the unfortunate citizens who has been declared unemployable due to being too old and unemployed. It is a daily struggle to stay alive and I never thought I would see the day when I would be grateful for Medicaid, but that is where I am at. I've been on the HIP waiting list for over 3 years. I need health care, but I can't afford it. Since hospitals have bought up the physician practices they now charge anywhere from $185 - $250 just to see a family practitioner! We all know that insurance companies, Medicare, and Medicaid don't pay anywhere near that amount for an office visit. However, if you are uninsured, they may offer you a 10-30% discount. That means it would cost me between $166.50 to $225 for a simple office visit. I have been priced out of the market for basic health care. If I can't get access to affordable health insurance coverage I would at least like to see a law that would demand uninsured people must be provided with the Medicare payment rates for service. Even then I would struggle to afford care, but it would prevent me from being locked out of basic care. Health care in this country is profit driven and stopped caring for patients back when mutual insurance companies got out of the market.
  • HIP is a joke
    I tried signing up for the Healthy Indiana Plan when I was unemployed. My daughter was put on a waiting list and never received any word about when she could enroll and I was told by one of the HIP staff that the plan was more expensive than getting my own plan through an insurance company. Fortunately I was able to find a good job with health insurance benefits but for many they don't have a choice.
  • Misleading
    I really wish administration officials would stop using the term, "consumer driven." These plans are nothing more than PPOs with a high deductible, which Medicaid pays most of. Once the deductible is met, the enrollees face the same network restrictions that apply to all PPOs. And, as J.K. has aptly demontrated in earlier columns, it's nearly impossible to "shop" for prices in the healthcare market. When HIP was first rolled out, I asked Mitch Roob why they were calling it "consumer driven," given these facts He just scowled at me. Question answered! (I would love to be a mouse in the room with Pence and Sebelius. She has a very low tolerance for BS like "consumer driven" and a whole lot more experience and substantial contributions under her belt. My money's on her having Pence for lunch -- but will do it diplomatically!)
  • No Truth
    There is absolutely no analytical proof that the below statement is true: “Unlike traditional Medicaid, the Healthy Indiana Plan gives its members ‘skin in the game’ with regard to their healthcare and lifestyle decisions,” Pence wrote. “As a result, Healthy Indiana Plan members utilize preventive care services more often and the emergency room less often than traditional Medicaid members.”
  • GOP has blood on its hands
    By limiting the number of Medicaid enrollments Pence is dooming thousands of Hoosiers to an early grave. HIP is very poorly run, which explains why it has greater number of people on the waiting list than are actually covered. HIP is nothing but a tax payer funded corporate give-away, secured with secret payments from the industry to GOP's political leaders.

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