Pence pitches health plan in DC, says not Medicaid

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INDIANAPOLIS (AP) — The health insurance expansion Gov.
Mike Pence is touting relies on federal Medicaid money and meets federal
Medicaid requirements, but the Republican governor insists it’s not
Medicaid.
Pence is asking the federal government to pay for an
expansion of the state’s Healthy Indiana Plan, saying his plan is much
better than traditional Medicaid. He took his pitch to Washington on
Monday, unequivocally telling an audience gathered at the conservative
American Enterprise Institute that his plan is nothing short of Medicaid
reform.
"Last week, my administration announced plans to submit a
waiver to the Centers for Medicare and Medicaid Services to replace
traditional Medicaid in Indiana for all able-bodied adults with an
expanded version of the Healthy Indiana Plan," he said.
But
national conservatives, his longtime support base, have been treating
his proposal as equivalent to the expansion of federal health care they
ardently oppose.
Whether Pence’s proposal is in fact an expansion of Medicaid may depend on point of view as well as how
"Medicaid" is defined.
Kosali
Simon, a health economist and professor at Indiana University’s School
of Public and Environmental Affairs, said the law creating Medicaid is
specifically designed to allow states to develop their own options for
administering the law. By that definition, Pence’s proposal is an
expansion of Medicaid.
"It’s Medicaid because it fits into the
definition of what states are allowed to do: States are allowed to ask
for waivers," Simon said.
But she notes that if one defines
Medicaid as "not deviating at all" from how the federal government asked
states to expand Medicaid, then Pence’s proposal is not Medicaid.
Indiana
is among a handful of states that have proposed accepting the federal
expansion of Medicaid on their terms. Arkansas and Iowa won waivers
allowing them expand Medicaid coverage with some key changes, like
providing payouts to low-income residents to purchase insurance on the
health insurance exchange.
Pence’s plan calls for a series of major changes from how Medicaid expansions in other states have
worked.
The
first part of the "Healthy Indiana Plan 2.0" would allow adults earning
less than 138 percent of the federal poverty level to enroll in the
state’s hybrid health savings account plan. If the residents pay a small
monthly fee, they would be enrolled in "HIP Plus," which provides
dental and vision coverage, as well as better prescription coverage. If
residents miss their payments, they would drop down to "HIP Basic,"
which does not include vision and dental coverage and other "extras".
"HIP
2.0" also establishes "HIP Link", a nod to Arkansas, which would have
the state subsidize low-income workers whose employers offer health care
benefits but are too expensive for the workers.
But the details
include some key features of Medicaid, specifically measures that Health
and Human Services officials asked for when they rejected a similar
proposal submitted by former Gov. Mitch Daniels. The addition of dental
and vision coverage, as well as not being able to kick residents out of
the program if they don’t make payments, were key features of the
federal Medicaid expansion.
And the program is also funded heavily by federal Medicaid dollars.
David
Roos, executive director of Covering Kids and Families of Indiana, and
other health care advocates in Indiana pushed hard for an expansion of
traditional Medicaid, but have largely rallied around Pence’s proposed
alternative.
The Pence proposal includes many key facets and requirements not found in traditional Medicaid, he said.

"It’s
definitely not Obamacare," Roos said. "I think it’s a new critter. I
think it’s exactly what (waivers) are supposed to be: it’s a
compromise."

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