Even as Indiana opponents of Obamacare shed crocodile tears for the few who may be forced to upgrade substandard medical insurance plans, they push ahead with a plan guaranteeing that thousands of Hoosiers will be left with no medical coverage at all.
The estimated 182,000 Hoosiers who will be shut out because the state declined the option of expanding Medicaid are, in sense, just collateral damage in an ideological battle.
The Pence administration, you see, wants to preserve the Healthy Indiana Plan, which requires that patients buy into their own coverage and, the theory goes, encourages them to use their health care prudently.
But HIP, which seemed a good idea when it began in 2008, has never lived up to expectations and today is decidedly unhealthy.
The plan was to help as many as 130,000 non-Medicaid-covered poor Hoosiers get access to health care. The program, though, never broke 50,000 and now is at about 31,000, according to Erik Gonzalez, a financial analyst for the Indiana Houses Democrats.
About 11,000 of those enrollees will be knocked off the plan next month by the terms of the one-year extension Indiana received from the federal government for the program. Christy Denault, press secretary for Gov. Mike Pence, said the net effect of restructuring will be to insure 20,000 Hoosiers who are not now insured by Jan. 1.
But that could leave thousands upon thousands of Hoosiers who could have been insured, not insured.
This is not just a battle of hidebound ideology vs. compassion.
It is a matter of dollars and cents and economic growth.
Simply reaching an accommodation with the federal government on expanding Medicaid would have cost the state about $503 million by 2020, according to a study prepared by the University of Nebraskas Center for Health Policy. But it would bring in much more than the state would give up.
In its study for the Indiana Hospital Association last spring, the Nebraska center estimated that accepting Medicaid expansion in Indiana would also, by 2020, bring in $10.45 billion in federal funds, which would, in turn, create new activity, new jobs and new tax revenue across the state.
New income aside, Indiana now is sitting on two burgeoning trust funds that could help ensure that the burden of adding health care recipients would not add costs to the state:
A portion of the state tax on tobacco products is dedicated to the HIP fund; that cache is now $307 million.
Another $395 million resides in the Medicaid trust fund, which exists to pay for unexpected expenses.
Over time, that $702 million might not sustain medical coverage plans for all Hoosiers who need them. But combine that with the federal subsidies and state revenue from resulting economic growth, and its fair to ask whether the concern about the costs of a Medicaid expansion in Indiana might be misplaced.
As Kentucky, Ohio, Illinois and Michigan move ahead with plans to provide for their poor, Indiana can sit by and watch its federal tax dollars flow back to the local economies in Chicago, Louisville, Kalamazoo and Toledo. Then the state can accept a new nickname: The Island of the Uninsured.
Or it can put a damper on its aversion to Obamacare, add a bit of common sense, and reach an accommodation with the federal government that will allow Indiana to provide for those in need and, it would appear, give us all an economic shot in the arm.