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Listening is key to health care compromise


If the first feedback from their Hoosier Healthcare Tour is any indication, congressman Larry Bucshon and state Rep. Tim Brown aren’t likely to change their views on the Affordable Care Act. What they shared Wednesday after a meeting at Lutheran Health Network only seemed to have strengthened their preference for an Indiana solution to the health care coverage shortfall.

Their willingness to acknowledge shortcomings in the present system and to look for a way forward, however, lends hope that Hoosiers won’t be left behind as other states move forward in providing coverage for the uninsured. When Brown, R-Crawfordville, an emergency room physician and chairman of the Indiana House Ways and Means Committee, says he’s more optimistic that the state can reach an agreement with the federal government to use its Healthy Indiana Plan to expand coverage, there’s reason for all to be optimistic.

Indiana is one of 24 states that have opted against expanding Medicaid eligibility under the federal health reform law, leaving as many as 400,000 Hoosiers in the gap between Medicaid eligibility and qualifying for subsidized insurance through the federal exchange.

The federal government has agreed to pay through 2016 the full cost to expand Medicaid. Its share would be reduced incrementally to 90 percent by 2020. But Bucshon, who represents the 8th District in southwestern Indiana, is adamant that the federal government’s budget problems will leave Indiana “holding the bag.”

Gov. Mike Pence’s talks with the Department of Health and Human Services have yet to produce an agreement to extend the HIP program beyond this year, but the Indianapolis Business Journal reported last week that his administration is talking with state hospital leaders about using the existing Hospital Assessment Fee to help cover the cost of expanding coverage for the uninsured. The assessment fee, which hospitals agreed to pay in 2011, was in exchange for higher Medicaid reimbursement payments. For $700 million in fees paid, Indiana hospitals were able to net $800 million from the $1.4 billion in federal funds triggered by the higher payments.

Doug Leonard, president of the Indiana Hospital Association, told the IBJ that the hospitals are open to exploring how the assessment fee could be used in the state’s health care expansion.

Brown said Wednesday the proposal was an example of the innovation the governor and others want to see in meeting the health care coverage requirements. He noted the provision in the 2010 Affordable Care Act in which the Disproportionate Share Hospital program, or DSH payments, which is to be phased out after 2017, should serve as an incentive for those hospitals serving large percentages of uninsured patients to work with the state in finding a solution. The DSH program provides federal dollars to hospitals to cover treating indigent patients.

If Indiana is to find a way out of the stand-off between the governor and federal government, negotiation and compromise offer the best path. As Bucshon and Brown continue their tour, Hoosiers across the state should encourage them to pursue that path.