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Late last year IBJ published an article regarding the Obama administration’s decision to add a second layer of oversight to the evaluation of the Healthy Indiana Plan 2.0, known as HIP 2.0.
Health is not the province of the Republican or the Democratic party. In 2007, I was part of a bipartisan effort to improve the quality of all Hoosiers’ health by raising the cigarette tax and using those proceeds to fund the first version of the Healthy Indiana Plan.
Much of that plan relied on the principle of people helping themselves, or personal reasonability. We built a series of incentives and disincentives into the larger plan. The plan called for the recipient to pay for a portion of his or her coverage; that expense would be reduced if preventative health screenings were conducted.
A similar bipartisan coalition emerged in 2013 to expand that plan as HIP 2.0. After long negotiations the Pence and Obama administrations agreed to a plan using a mechanism in the Medicaid laws called an 1115b waiver. Implemented last year, it has already enrolled 360,000 Hoosiers.
As part of this plan an evaluation will take place. As in the past, an outside firm was selected, with the approval of the Obama administration, to review HIP 2.0. Suddenly and without precedent, the Obama administration has hired a second contractor to do a second evaluation of the HIP 2.0 program.
This begs the question: Why? Why was the first review team OKed by the Obama folks and yet they feel compelled to hire a second?
Let’s be clear, forging a bipartisan consensus on health care required some compromise, from both sides. Neither side got exactly what it wanted. This is how Medicaid is designed—as a federal and state partnership. It is funded with tax dollars raised by both Congress and, in Indiana’s case, the General Assembly. It is administered by employees of the state’s executive branch, within the construct of regulations promulgated by employees of the federal executive branch.
Perhaps some in Washington wished for a national single-payer program to fund the health care needs of those currently covered by Medicaid. But that is not how Congress and the states originally designed Medicaid, nor has it evolved that way through legislative and administrative action.
Even the so-called Obamacare legislation called for engagement by the states in developing innovative solutions to the unique health care needs of people living in rural and urban communities, served by a local—not national—set of health care providers.
In the case of HIP 2.0, both the Obama and Pence administrations felt their compromise was a small price to pay for the larger goal of insuring more people.
But once a deal is done, let’s keep it done. Hiring a second contractor to review a plan is at best a disingenuous waste of money. At worst, it is an overt attempt to “claw back” some of the provisions of personal responsibility agreed to by the Obama administration before those provisions become part of other states’ plans.
All good ideas do not come from within the D.C.-area beltway.
This kind of action by the federal government undermines the spirit of cooperation necessary to effectively implement a jointly-funded program like Medicaid. Worse still, it undermines the long history of bipartisanship in health care that has marked the last 20 years of progress in Indiana.
Mr. President, leave this deal alone.•
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