We generally are aware that a handful of Republican-run states are still toying with accepting Obamacare’s expanded Medicaid services, mostly via negotiations with HHS over ways to use the federal dollar bonanza to do the kind of things Republicans like to do. I wouldn’t have initially guessed Indiana might be the next state to cross the line. Wonkblog‘s Jason Millman reports otherwise:
It looks as if Indiana is about to join the list of red states signing up for Obamacare’s Medicaid expansion.
Republican Gov. Mike Pence, after months of discussions with the Obama administration, is offering a new plan Thursday morning to expand coverage to low-income uninsured Hoosiers. As expected, he’s doing it through an existing state insurance program for adults that’s been championed by some conservatives.
That would be Mike Pence, former chairman of the conservative House Republican Study Committee, and a prospective candidate for president in 2016. Wouldn’t going along with any Medicaid expansion put him into Christie-land?
I don’t know for sure, but what may make this palatable for Pence (and other conservatives) is that the expanded state plan he’s getting the feds to pay for is based heavily on the most ancient conservative pet rock in health care policy, the Health Savings Account:
Pence last year insisted that he would only expand coverage if he could do it through the Healthy Indiana Plan, a health savings account-type of program for about 45,000 adult Hoosiers who didn’t qualify for the traditional Medicaid program.
The Obama administration maintained that Indiana couldn’t expand Medicaid through HIP because the program had an enrollment cap, and some cost-sharing features may have been problematic. HIP’s design has been praised by conservatives for requiring Medicaid beneficiaries to be more conscious consumers because they take more financial responsibility for their care.
But now Pence is making some compromises on enrollment caps and cost-sharing requirements, and Indiana and HHS are getting close to an agreement.
Maybe it will fall through, and there’s surely a lot about the Indiana program I don’t know or don’t understand. But it could be that Pence is going where I’ve always thought a smart if cynical Republican ought to go: cutting a deal that would let the feds pay for conservative experimentation with health care, and then once it’s signed, gloating that he’d tricked Barack Obama into helping dig a grave for Obamacare and all those other socialized medicine schemes.
We may soon see if that’s Pence’s plan, and if it will play in Peoria–or more precisely, in the Pizza Ranches of Iowa.