Does Mitch Daniels’ Medicaid Reform Program Really Work?

Jonathan Cohn offers some insight into Gov. Mitch Daniel’s (R-IN) much touted Medicaid reform program (The Healthy Indiana Plan), which Republicans are presenting as the anti-Obamacare success. Cohn explains that the plan — while built on the conservative philosophy that people would use less care if they had more skin in the came — pairs a high deductible health care plan with a health savings account (standard conservative fare) but also includes some rather progressive elements that are also part of the Affordable Care Act:

In some respects, though, the program is not as conservative as its reputation suggests. For one thing, Healthy Indiana applies cost-sharing with discretion. The monthly contributions into the Power Accounts [ vary between 2 percent and 5 percent of income, with the poorer recipients paying a smaller share than the richer ones. And that’s only for people who have incomes. About one-third of the program’s beneficiaries pay nothing at all. The state also regulates the insurers that participate in Healthy Indiana, requiring that they cover preventative care free of charge. These are the sorts of features favored by liberals, most of whom agree there should be some “skin in the game” but worry about placing excessive burdens on the poor and chronically ill.

Still, Healthy Indiana would not meet most liberals’ expectations — because it doesn’t really qualify as adequate insurance. The program doesn’t require coverage of vision, dental or even maternity care. It also has lifetime caps on benefits, the kind that the very sickest patients inevitably reach. “The track record of Healthy Indiana to date does not show that it is a truly affordable, accessible program for all uninsured adults in Indiana,” says Roos, noting that even token financial contributions can be a real hardship.

That last part about adequate coverage is really key because Medicaid spends most of its money on low-income disabled and elderly population who need chronic care and can’t afford to pay for it. Daniels’ approach — like the general conservative principle about high deductible coverage — won’t work for this population and Republicans in the state seem to be exploring ways to bolster the coverage provisions.

So it’s certainly not perfect, but it’s some kind of a start that offers us an important glimpse of how the GOP’s “skin in the game” health care theories operate in practice.