By Phil Galewitz
Wed, Jan 28 2015
The deal reached Tuesday between the Obama administration and Indiana Gov. Mike Pence to expand Medicaid under the president’s health law should help sway reluctant Republican officials in other states because it imposes new costs on poor adults, promotes healthy behaviors and relies on financing from smokers and hospitals instead of state taxpayers, health experts say.
Pence, a potential GOP presidential candidate in 2016, won a three-year waiver from the federal government to make Medicaid more like private insurance by including cost-sharing for recipients below the poverty level.
Under the agreement, Indiana will pay for its share of the expansion costs beginning in 2017 with hospital fees and a cigarette tax. “It’s a great talking point,” to answer opponents who question how states will pay their share of the program’s costs, said Joan Alker, executive director of the Georgetown Center for Children and Families. “This is really an important feature.”
The agreement, which will take effect next week, makes Indiana the 28th state to expand the federal-state insurance program to insure everyone under 138 percent of the federal poverty level, or $16,100 annually for an individual.
About 350,000 Indiana residents are expected to qualify.
Republican lawmakers in Florida, Texas and other states have resisted expanding the program in part because they’re against giving non-disabled adults “free” health coverage. They also worry about having to pick up some costs after 2016 when the federal government stops paying the full bill. Federal funding gradually declines to no less than 90 percent of costs beginning in 2017.
“I think this raises the level of interest in looking at these issues in states that have not expanded Medicaid,” said Joe Antos, a health economist at the conservative American Enterprise Institute. “Lawmakers in Texas may not be influenced but there are other states that will want to know more.”
Several states are expected to debate Medicaid expansion this winter and spring including Florida, Tennessee, Wyoming, Utah and Montana.
But critics of the Indiana deal warn the complexity of the program could make it harder for poor people to get health care and will require major education to teach people how to use so-called “POWER accounts,” modeled on private sector health savings accounts which the state requires to pay the premiums.
source : Indiana Medicaid Expansion May Tempt Other GOP-Led States
