The following is part of The Exponent’s continued coverage of the Affordable Care Act. Over the next few weeks, we hope to educate readers on different sections and details of the act.
Despite the hype surrounding the Affordable Care Act, over 300,000 Hoosiers will be left uninsured due to a gap between the new mandate and existing Medicaid coverage.
The Supreme Court ruled last June in the case of National Federation of Independent Business vs. Sebelius the States had to open their own health care exchanges for the ACA tax credit, or mandate, to operate within. The ruling also carried the provision the States did not have to expand their Medicaid coverage to include people below the poverty line who will not be covered by either system – the original intention of the ACA.
Though the number is shrinking every day, 27 states have yet to pass legislation to go along with expansion. The Kaiser Family Foundation estimates that 5.2 million Americans are left uninsured.
A press release by the Indiana Governor’s office in February opened with the definitive line, “Gov. Mike Pence flatly refuse(s) to expand the traditional Medicaid program in Indiana.” However, an alternative solution was offered. The accompanying letter by Pence reaffirmed his stance that “the Healthy Indiana Plan should serve as the starting point for all future discussion on health care reform in Indiana.”
The Healthy Indiana Plan, instituted in 2008, is a social safety net system similar to Medicaid, which caps its coverage to 45,000 citizens within the state. In its current form, though, the insurance coverage is not as extensive as what would be offered under Medicaid expansion or through the ACA. Pence is working with the federal government on a proposal to expand. Currently, details are scarce.
Sheila Rosenthal, a local political activist and an active member of the Democratic Party, is one such Hoosier who maintains the Healthy Indiana Plan won’t be able to expand sufficiently. She knows the ACA needs a consistent process of improvement and editorial legislation – constructive criticism it can’t get as it is right now. She hopes the Republicans in conservative states will allow the legislation to be implemented as it was intended when passed in 2010.
“This is the biggest change to health care in decades,” Rosenthal said. “You can’t expect it to be a perfect law ... Imagine if they blocked Medicaid legislation like this back then (in 1965.)”
Rosenthal is aware there are budgetary gaps predicted in Indiana’s future, but doesn’t forget that the healthcare gap will be a reality for millions if a plan is not enacted by the ACA’s March insurance sign-up deadline.
“We need to realize that (the ACA) really is going to help a lot of people,” she said. “It just needs time.”
Budgetary woes figure into the governor’s stance. According to the Center on Budget and Policy Priorities, the state will spend $1.1 billion by 2022 if Medicaid expansion is passed. It will still spend $286 million if nothing at all is done to expand coverage.
Pressure from Republicans in the U.S. House of Representatives is another factor. The federal government has offered to cover every state’s first three years of the expansion expenses and afterwards 90 percent of annual costs. Indiana has refused this money. It is unclear yet how much Indiana’s budget shortfalls may actually increase under each future scenario.
Political science professor Bert Rockman notes the White House “has been pretty liberal about giving out Medicaid waivers” to states if an alternative is produced. He believes students won’t be affected much.
“Purdue has its own insurance program that is part of tuition, but it’s only a clinical wellness program,” Rockman said. “In most cases, undergrads will be dependents of their parents and covered by them. For those who are not dependents and have no taxable income or only work part-time – if something goes beyond Purdue’s coverage – they might qualify for Medicaid.”