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The Journal Gazette

Tuesday, December 01, 2015 6:45 pm

It's a win-win-win

When President Barack Obama flew into Evansville last month, he allotted some "tarmac time" for a chat with Gov. Mike Pence.

The subject was Pence’s request to the federal government to let Indiana use money the federal government is empowered to allocate for Medicaid expansion to expand the Healthy Indiana Plan instead.

During a meeting with The Journal Gazette’s editorial board Wednesday, Pence told us a little about the brief but seemingly cordial and productive conversation he had with the president about Indiana’s HIP 2.0 proposal. 

 "I said, ‘Mr. President, you know every state that comes to you with a waiver proposal for Medicaid is offering you an idea. Ours is not an idea – it’s a program. I’ve got 60,000 people in the program.’â "

Pence said the conversation with Obama was just one of many he and other state officials have been having with people in the administration, including presidential aide Valerie Jarrett and Health and Human Services Secretary Sylvia Burwell, who took office in early June. "Since she’s come in, it’s been a pretty regular dialogue," said Pence, who spoke with Burwell on the phone Tuesday.  

But Indiana submitted its request for HIP 2.0 approval on July 1. And as Obamacare began its second round of enrollment this weekend, state officials still were waiting for approval from the federal Centers for Medicare and Medicaid services.

A lot is at stake. Health care coverage for hundreds of thousands of people in the "gap" – primarily working Hoosiers whose income is too high for Medicaid coverage but too low to qualify for tax credits to pay for insurance on the Obamacare exchange. Thousands of jobs that the infusion of federal funds through HIP 2.0 would help create. The very existence of some Indiana hospitals that are counting on HIP 2.0 to create a whole new market of patients who will be covered for the care they need – care that those facilities sometimes now must provide at a loss.

Aside from a few minor details, the hangup appears to be HIP 2.0’s small monthly fee for full medical coverage.  

Created in 2007, HIP was an attempt to offer comprehensive health care to uninsured families while requiring users to make a monthly contribution to a personal health care fund.

The theory was that those who have some of their own money on the line are more likely to take responsibility not only for making good decisions on medical costs but for taking care of their own health. Hoosiers enrolled in the program seem to like it, but its enrollment was capped and a large number of uninsured were left on the waiting lists. 

Obamacare attempted to address such gaps by offering states the option of expanding Medicaid programs to cover those who fell short of the income levels that qualified for medical insurance tax credits. Pence – opposed to straight Medicaid expansion – proposed a creative conservative option: Let Indiana use the money to expand HIP 2.0. Under Pence’s plan, there’s a basic-coverage net that would protect those under the federal poverty level even if they failed to pay into their monthly accounts.  

But HIP-plus would provide full medical coverage to those in the coverage gap who pay into their personal health care accounts on a sliding scale according to their income.

 Is that part of the deal worth debating? Absolutely. But should it be a deal-breaker? We think not. The cost is $3 to $25 a month, and users seem to find a way to come up with those dollars; as Pence points out, 93 percent of current HIP users now pay into those accounts on time. 

  "We actually think, working with our health care community, that most people are going to choose the HIP-plus plan," Pence said. "It’s got better benefits, but it does require you to make a contribution. And I think the incentives and the consequences of payment and nonpayment are vitally important to this succeeding as a consumer-driven program."

Federal approval and implementation of HIP 2.0 would allow the Pence administration to pursue its conservative approach to solving the health care program. And it would allow the Obama administration to further its goal of insuring the uninsured.

It’d be a win-win-win scenario: for the president, for the governor and, most of all, for Indiana. But, as Pence said, "time is of the essence."