Indiana governor and potential 2016 presidential candidate Mike Pence (R) embraced a key portion of the Affordable Care Act on Thursday, becoming the ninth Republican governor to support expanding health coverage to residents below 138 percent of the federal poverty line and accept millions in funding from the health care law. GOP governors in three other states — Pennsylvania, Utah, and Florida — have also indicated a willingness to work with the federal government to cover the low-income population.
Pence’s announcement also comes as national Republicans have shifted their focus from repealing Obamacare to investigating the 2012 attacks in Benghazi, Libya and have struggled to craft a united message on repealing the health care law since the end of the first open enrollment period.
“I have long believed that a society can be judged with how it deals with the most vulnerable,” Pence said, noting that 350,000 Hoosiers currently find themselves in a “coverage gap” where they earn too much to qualify for traditional Medicaid and aren’t eligible for other health care programs or subsidies in the Obamacare marketplaces.
Stressing that he opposed enrolling more low-income residents into the existing Medicaid program, Pence announced that he would be applying for a waiver from the Obama administration that would allow the state to use federal funds intended for Medicaid expansion to pay for coverage though the state’s Healthy Indiana Plan or HIP, a market-based alternative. However, in order to qualify for federal dollars, Indiana will have to provide all beneficiaries with a Medicaid-prescribed minimum benefit package and other protections found in the Medicaid program.
Under the so-called HIP 2.0 proposal, residents ages 19 to 64 with incomes up to 138 percent of the federal poverty level can receive premium assistance accessing employer sponsored plans. Individuals who make contributions to a health savings account will be able to enroll in HIP plus, which will offer an enhanced benefit plan that covers dental and vision care. Beneficiaries who cannot afford to contribute to a health savings account will have access to a HIP basic plan that will provide essential health benefits and will require co-payments for all services. Families with incomes above 100 percent of the poverty level would have access only to the HIP Plus plan. The initiative will be funded by Indiana’s existing cigarette tax revenue and Hospital Assessment Fee program, along with federal Medicaid funding.
“We are encouraged by Indiana and Governor Pence’s commitment to helping cover more of the state’s uninsured population through the Healthy Indiana program and look forward to seeing his proposal,” Health and Human Services spokesperson Emma Sandoe said. She noted that the administration has worked with Arkansas and other states to craft unique alternatives to Medicaid expansion.
If the federal waiver is approved, Indiana will become the 27th state, along with Washington D.C. to expand coverage to Americans who were supposed to be covered by an expanded Medicaid program. Meanwhile, rural hospitals in states that have resisted the expansion and have failed to pursue state-based alternatives — Tennessee, Georgia, North Carolina, and Virginia — have been forced to shut down due to an influx of uninsured patients who cannot pay for medical care. Under the Affordable Care Act, the federal government will fully fund Medicaid expansion until 2016 and will pick up more than 95 percent of the cost for the next 10 years.
During the announcement, Pence reiterated his opposition to the Affordable Care Act and called on Congress to block grant the Medicaid program.