IBJOpinion

RUSTHOVEN: An Indiana Obamacare snapshot

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RusthovenObamacare’s calamitous launch, including the widening gap between promise and reality, continues to consume political discourse. Here’s a quick summary of Indiana’s status:

• Over the first month, only 700 Hoosiers chose policies on healthcare.gov. This includes anyone who put anything in a shopping cart, even if they bought nothing. For your information, Internet shopping cart abandonment rates average about 75 percent.

• As Hoosiers know, Gov. Pence declined to have Indiana set up its own “state-run exchange,” which would have cost Hoosier taxpayers $50 million. Some 25 other states made the same choice. This looks smarter every day.

• Pence also declined Obamacare’s “invitation” to expand Medicaid. The act made this a command, but the Supreme Court struck that down. Pence then chose not to trust the deficit-ridden federal government to keep promises about reimbursing expansion costs.

Pence knows Washington, knows Medicaid reform is part of any serious future deficit fix, and knows Hoosiers would be stuck when future reimbursement proves—to use The New York Times’ delicate phrase for the president’s “you can keep your plan” pledge—an “incorrect promise.”

• On Medicaid expansion, about half the states again took the same prudent course. Unlike most, however, Indiana has a sound alternative—if Washington lets us keep it.

The Healthy Indiana Plan, established under Gov. Daniels, takes a “savings plan” approach emphasizing consumer direction and responsibility in providing health insurance for low-income Hoosiers (up to 200 percent of the poverty level). HIP has over 90-percent satisfaction, and enrollment of 37,000 (with 52,000 more on the waiting list).

Pence worked hard negotiating a waiver from Obamacare that saves HIP for another year—at least mostly. The Obama team insisted on eliminating HIP for anyone over the poverty line. This kicks 11,000 Hoosiers off a state program that works, sticking them in a federal one that doesn’t.

• Obamacare’s tax on medical devices—half made here, by companies employing 20,000 Hoosiers—hits Indiana hard. Other adverse job impact will be partially deferred by Obama’s unilateral (and unlawful) temporary suspension of the employer mandate. But pain is starting.

Health care providers (Indiana University Health, St. Vincent Health, Franciscan Alliance) have cut jobs due to Obamacare costs. School districts, unable to afford either the insurance mandate or fines for noncompliance, are eliminating positions and making others part time. Fifteen districts, with state support, have now sued, challenging federal power to fine states and public schools.

For this, State Rep. Ed DeLaney, D-Indianapolis, says Pence and Attorney General Greg Zoeller “are trying to compete with Bangladesh”—not sure what that means, but it sounds like an insult—adding, “Those two can go secede, but don’t take my health insurance away and don’t take it away from anybody else.”

This captures some Democratic thinking, which sees health insurance as a government-conferred benefit, and views challenging Obamacare as disloyal (even “secessionist”), motivated by desire to “take away” that benefit.

• Other Indiana Democrats are backing away. Two weeks back, this column noted that Sen. Joe Donnelly was silent on legislation by Sen. Mary Landrieu, D-La., to allow folks to keep their health plans, as the president promised they could. Last week, Donnelly co-sponsored Landrieu’s bill.

Then there’s former Sen. Evan Bayh, Indiana’s most reliable political weathervane. Bayh, another Obamacare supporter, now says its medical-device tax must be repealed and its individual mandate delayed. Think DeLaney will tell him to “go secede”?•

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Rusthoven, an Indianapolis attorney and graduate of Harvard College and Harvard Law School, was associate counsel to President Reagan. Send comments on this column to ibjedit@ibj.com.
 

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  • Ponderable
    I've been reading a good deal of information both pro and con on obamacare, I'd like to pose a question. According to Vice President John C. Calhoun (1816), "if a state found a federal law unconstitutional and detrimental to its sovereign interests, it would have the right to "nullify" that law within its borders. Calhoun advanced the position that a state could declare a national law void." Is obamacare in Indiana "unconstitutional and detrimental" for its citizens health and economical stability?

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  1. to mention the rest of Molly's experience- she served as Communications Director for the Indianapolis Department of Public Works and also did communications for the state. She's incredibly qualified for this role and has a real love for Indianapolis and Indiana. Best of luck to her!

  2. Shall we not demand the same scrutiny for law schools, med schools, heaven forbid, business schools, etc.? How many law school grads are servers? How many business start ups fail and how many business grads get low paying jobs because there are so few high paying positions available? Why does our legislature continue to demean public schools and give taxpayer dollars to charters and private schools, ($171 million last year), rather than investing in our community schools? We are on a course of disaster regarding our public school attitudes unless we change our thinking in a short time.

  3. I agree with the other reader's comment about the chunky tomato soup. I found myself wanting a breadstick to dip into it. It tasted more like a marinara sauce; I couldn't eat it as a soup. In general, I liked the place... but doubt that I'll frequent it once the novelty wears off.

  4. The Indiana toll road used to have some of the cleanest bathrooms you could find on the road. After the lease they went downhill quickly. While not the grossest you'll see, they hover a bit below average. Am not sure if this is indicative of the entire deal or merely a portion of it. But the goals of anyone taking over the lease will always be at odds. The fewer repairs they make, the more money they earn since they have a virtual monopoly on travel from Cleveland to Chicago. So they only comply to satisfy the rules. It's hard to hand public works over to private enterprise. The incentives are misaligned. In true competition, you'd have multiple roads, each build by different companies motivated to make theirs more attractive. Working to attract customers is very different than working to maximize profit on people who have no choice but to choose your road. Of course, we all know two roads would be even more ridiculous.

  5. The State is in a perfect position. The consortium overpaid for leasing the toll road. Good for the State. The money they paid is being used across the State to upgrade roads and bridges and employ people at at time most of the country is scrambling to fund basic repairs. Good for the State. Indiana taxpayers are no longer subsidizing the toll roads to the tune of millions a year as we had for the last 20 years because the legislature did not have the guts to raise tolls. Good for the State. If the consortium fails, they either find another operator, acceptable to the State, to buy them out or the road gets turned back over to the State and we keep the Billions. Good for the State. Pat Bauer is no longer the Majority or Minority Leader of the House. Good for the State. Anyway you look at this, the State received billions of dollars for an assett the taxpayers were subsidizing, the State does not have to pay to maintain the road for 70 years. I am having trouble seeing the downside.

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