Indiana’s Pence Makes Progress with Innovative Medicaid Expansion
The Indianapolis Star reports that Indiana Republican Governor Mike Pence, a possible 2016 presidential candidate, cleared an important hurdle today when the state’s House Public Health Committee approved a bill to expand Medicaid eligibility without relying on ObamaCare’s open-ended spending incentives.
Pence’s plan would increase Indiana’s Medicaid enrollment by an estimated 400,000, but within the state’s Healthy Indiana initiative begun in 2007. As a health savings account, Healthy Indiana allots a certain amount of money to qualifying Hoosiers who then shop for doctors and treatment options within their budget. In effect, it transfers the decision making process for health care away from government bureaucrats to private citizens. By capping the amount, Healthy Indiana also gives state budget writers more certainty about the cost of Medicaid expansion in future years.
Contrast this with the unlimited spending commitment envisioned by the Medicaid expansion system under ObamaCare, and conservatives will see why Pence’s proposal should be watched closely. Under ObamaCare, states would pay no cost for expanding their eligibility pool up to 138 percent of the federal poverty line. But starting in 2017, those that expanded enrollment would pay for 10 percent of the increase. Though seemingly a small percentage, the costs will run into the billions, with even more likely if the federal government decides to reduce its 90 percent subsidy, as President Barack Obama has already hinted at doing.
The future of health insurance reform looks like it will include some mix of government-regulated exchanges, subsidies, and cost controls. The question dividing conservatives like Mike Pence and Paul Ryan on one hand from liberals like Obama on the other, is who gets to make the lion’s share of the decisions on how health insurance dollars are spent. Conservatives value individual choice, while liberals favor centrally planned mandates.
Ironically, if the President wants ObamaCare to be fiscally sustainable, he’ll have to accept that the only way to do it is allowing conservatives like Pence and Ryan to inject into it as much personal freedom as possible.