Consider it a high-stakes exam.
Responses submitted by the three Indiana gubernatorial candidates to Gov. Mitch Daniels’ request for input on a state-based health exchange represent a good opportunity for voters to grade the prospective state leaders on a substantive policy issue. It’s a unique chance to move beyond the usual campaign rhetoric and assess real leadership.
Indiana and other states face a Nov. 16 deadline for submitting a plan for an exchange – a private health insurance marketplace where people not covered through their employers would shop for health insurance at competitive rates. The goal is to help consumers choose the best coverage with a tool to compare terms and allow users to see whether they qualify for expanded Medicaid or a subsidy to help pay premiums.
Daniels could have left the task undone or made the decision himself, so it was admirable for him to acknowledge that Libertarian Rupert Boneham, Democrat John Gregg or Republican Mike Pence will ultimately be responsible for carrying out administration of the plan and should have input in its selection.
How the candidates respond to Daniels’ request should be enlightening. As the governor notes, Indiana must be prepared to implement an exchange now that the provision of the Affordable Care Act has been upheld by the U.S. Supreme Court. But states have the option of creating their own exchange, leaving it to the federal government or coming up with a hybrid system.
States also have discretion in establishing the role of the exchange in contracting with health plans. All must meet minimum federal requirements for qualified health plans, but Indiana could choose to set up its exchange as a clearinghouse for all qualified health plans or contract with selected health plans and/or negotiate premium prices.
The state also must decide on the Essential Health Benefits package for small and individual group markets that will be required by 2014 but which must be selected by September. If no decision is made, the U.S. Department of Health and Human Services will automatically use the state’s largest small-group plan. The latter decision is an important one, determining which plan will offer coverage in 10 required categories of care, including prescription services, hospitalization, preventive and wellness services, and behavioral health treatment.
The question of Medicaid expansion is one that doesn’t have to be made until after the new governor takes office.
As for the pending questions, Indiana voters should look for evidence of a thoughtful and well-researched response from the candidates.
Congressman Pence has made his opposition to the federal health care law clear, but his response to Daniels’ request should go beyond political posturing to acknowledge the reality of the task facing the state. Gregg hasn’t released any detailed views on the issue; those views should be known to voters.
To its credit, Boneham’s campaign quickly accepted Daniels’ helpful offer to make his staff available for a briefing on the issue.
The benefit now will be for voters to see how the candidates respond.