Pressure rises on lawmakers to expand Medicaid

Back to TopCommentsE-mailPrintBookmark and Share

Up until now, Gov. Mike Pence and his fellow Republicans in the Legislature have been playing a game of poker with the Obama administration over a potential expansion of Indiana’s Medicaid program. But all of a sudden, Indiana’s hand just got quite a bit weaker.

Pence reiterated last week that he won’t support raising eligibility for the Indiana Medicaid program to 138 percent of the federal poverty limit—unless Obama’s Department of Health and Human Services lets the state use its Healthy Indiana Plan as the vehicle for that expansion.

So far, the feds have given an unofficial “no” to that request.

Since the Supreme Court’s June decision allowed states to opt out of the Medicaid expansion prescribed by Obama’s Patient Protection and Affordable Care Act, Indiana leaders have figured they could use that “opt-out” possibility to exact flexibility from the Obama administration.

But in just the past month, Obama’s team has been able to win over three conservative Republican governors—Arizona Gov. Jan Brewer, Ohio Gov. John Kasich and Michigan Gov. Rick Snyder—without making such promises of flexibility.

The governors were concerned that not expanding Medicaid could put some of their states' rural hospitals out of business.

Their support does not guarantee that those states’ legislators will, indeed, vote to expand Medicaid, but it certainly adds momentum to proponents of expansion.

Indiana now is surrounded on all sides by states that have indicated they are likely to expand Medicaid.

“That certainly puts a little bit of pressure on the governor,” said Ed Feigenbaum, publisher of the Indiana Legislative Insight newsletter. “And it gives a little more credibility to the Democrats [who are arguing that Medicaid expansion is] going to be the public policy of the country, and if we want to protect our people and protect our businesses, this is something we need to consider.”

And Medicaid expansion is on the table. This week, Republican legislators in the House and Senate will introduce language into existing bills that would require the state to expand Medicaid—although they likely will reiterate Pence’s call for the state to use the Healthy Indiana Plan to do it.

That plan, created in a bipartisan effort in 2007, expanded health insurance coverage to about 40,000 Hoosiers using health savings accounts to which most recipients are required to contribute at least a small amount.

That feature is the sticking point for the Obama administration, said Seema Verma, a health care consultant who has been the point person on health reform for the state of Indiana.

“It's that we require people to make contributions. That really flies in the face of the entitlement thing,” Verma said during a luncheon speech Friday at a conference on health reform in Indianapolis. The conference was staged by the Center for the Business of Life Sciences at the Indiana University Kelley School of Business.

What’s at stake in the decision is coverage for roughly 300,000 Hoosiers who have incomes below the federal poverty limit yet higher than the income threshold for Indiana’s Medicaid program.

The federal poverty limit is $11,170 for a single adult or $23,050 for a family of four. But Indiana Medicaid does not allow childless adults to enroll in Medicaid unless their incomes are just 25 percent of those limits.

Hospitals are desperately lobbying for the state to expand Medicaid. They agreed with the Obama administration to support cuts in federal payments to hospitals to cover health care for the uninsured, in hopes of receiving more money as the law expanded coverage to an estimated 27 million more Americans.

But since the Medicaid expansion was supposed to achieve about half of that expansion, hospitals face the prospect of reduced payments with only a modest increase in paying customers.

On Monday, the Indiana Hospital Association released a study claiming the Medicaid expansion would add $3.4 billion to Indiana’s economy per year.

But it would come at a cost to the state. A study by the actuarial firm Milliman Inc., produced at the request of former Gov. Mitch Daniels, estimated the Medicaid expansion would cost the state an average of $140 million per year from 2014 to 2020.

Another set of estimates, produced by the Urban Institute, a left-of-center think tank based in Washington, D.C., pegged the cost of expansion at less than $54 million per year.

Feigenbaum said he expects Indiana’s lawmakers to come up with a solution this session that expands Medicaid but in a way that minimizes the cost to the state. And then, like the Legislature did with the Healthy Indiana Plan, they’ll take the risk of getting it approved by the federal government.

“If I had to guess at this point, I would say that there would be an expansion but not in a form that anybody forecasts at this point,” Feigenbaum said. “That we’ll come up with a unique and innovative way of doing it within the rules, that will still help more people but wouldn’t have as deep a fiscal impact.”


  • of course...
    ...the Republicoins could just admit that THEY have NO answers for the uninsured and under-insured) in this stae/ country and universal, single-payer health care is the BEST answer for all but the for-profit health insurance companies...but since we KNOW the Republicons are OWNED by corporate 'Merka and take their marching orders from their overlords, actual citizens will continue to suffer and die...real 'family values' kinda folks ain't they

Post a comment to this story

We reserve the right to remove any post that we feel is obscene, profane, vulgar, racist, sexually explicit, abusive, or hateful.
You are legally responsible for what you post and your anonymity is not guaranteed.
Posts that insult, defame, threaten, harass or abuse other readers or people mentioned in IBJ editorial content are also subject to removal. Please respect the privacy of individuals and refrain from posting personal information.
No solicitations, spamming or advertisements are allowed. Readers may post links to other informational websites that are relevant to the topic at hand, but please do not link to objectionable material.
We may remove messages that are unrelated to the topic, encourage illegal activity, use all capital letters or are unreadable.

Messages that are flagged by readers as objectionable will be reviewed and may or may not be removed. Please do not flag a post simply because you disagree with it.

Sponsored by

facebook - twitter on Facebook & Twitter

Follow on TwitterFollow IBJ on Facebook:
Follow on TwitterFollow IBJ's Tweets on these topics:
thisissue1-092914.jpg 092914

Subscribe to IBJ
  1. Cramer agrees...says don't buy it and sell it if you own it! Their "pay to play" cost is this issue. As long as they charge customers, they never will attain the critical mass needed to be a successful on company...Jim Cramer quote.

  2. My responses to some of the comments would include the following: 1. Our offer which included the forgiveness of debt (this is an immediate forgiveness and is not "spread over many years")represents debt that due to a reduction of interest rates in the economy arguably represents consideration together with the cash component of our offer that exceeds the $2.1 million apparently offered by another party. 2. The previous $2.1 million cash offer that was turned down by the CRC would have netted the CRC substantially less than $2.1 million. As a result even in hindsight the CRC was wise in turning down that offer. 3. With regard to "concerned Carmelite's" discussion of the previous financing Pedcor gave up $16.5 million in City debt in addition to the conveyance of the garage (appraised at $13 million)in exchange for the $22.5 million cash and debt obligations. The local media never discussed the $16.5 million in debt that we gave up which would show that we gave $29.5 million in value for the $23.5 million. 4.Pedcor would have been much happier if Brian was still operating his Deli and only made this offer as we believe that we can redevelop the building into something that will be better for the City and City Center where both Pedcor the citizens of Carmel have a large investment. Bruce Cordingley, President, Pedcor

  3. I've been looking for news on Corner Bakery, too, but there doesn't seem to be any info out there. I prefer them over Panera and Paradise so can't wait to see where they'll be!

  4. WGN actually is two channels: 1. WGN Chicago, seen only in Chicago (and parts of Canada) - this station is one of the flagship CW affiliates. 2. WGN America - a nationwide cable channel that doesn't carry any CW programming, and doesn't have local affiliates. (In addition, as WGN is owned by Tribune, just like WTTV, WTTK, and WXIN, I can't imagine they would do anything to help WISH.) In Indianapolis, CW programming is already seen on WTTV 4 and WTTK 29, and when CBS takes over those stations' main channels, the CW will move to a sub channel, such as 4.2 or 4.3 and 29.2 or 29.3. TBS is only a cable channel these days and does not affiliate with local stations. WISH could move the MyNetwork affiliation from WNDY 23 to WISH 8, but I am beginning to think they may prefer to put together their own lineup of syndicated programming instead. While much of it would be "reruns" from broadcast or cable, that's pretty much what the MyNetwork does these days anyway. So since WISH has the choice, they may want to customize their lineup by choosing programs that they feel will garner better ratings in this market.

  5. The Pedcor debt is from the CRC paying ~$23M for the Pedcor's parking garage at City Center that is apprased at $13M. Why did we pay over the top money for a private businesses parking? What did we get out of it? Pedcor got free parking for their apartment and business tenants. Pedcor now gets another building for free that taxpayers have ~$3M tied up in. This is NOT a win win for taxpayers. It is just a win for Pedcor who contributes heavily to the Friends of Jim Brainard. The campaign reports are on the Hamilton County website. http://www2.hamiltoncounty.in.gov/publicdocs/Campaign%20Finance%20Images/defaultfiles.asp?ARG1=Campaign Finance Images&ARG2=/Brainard, Jim