How GOP Governors Can Make Peace With Obamacare’s Medicaid Expansion

Hint: Don’t call it Medicaid expansion. Or Obamacare.

House Republican Conference Chairman Mike Pence looks out over the crowd as US President Barack Obama answers a question at the Republican GOP House Issues Conference in Baltimore, Maryland, January 29, 2010. AFP PHOTO / Saul LOEB (Photo credit should read SAUL LOEB/AFP/Getty Images)
National Journal
Sophie Novack
May 19, 2014, 9:43 a.m.

Re­pub­lic­an In­di­ana Gov. Mike Pence wants to re­peal Obama­care. But in the mean­time, he’ll ac­cept fed­er­al funds for the health law’s Medi­caid ex­pan­sion.

Pence an­nounced in a turn­around last week that he would take the ex­pan­sion money to grow the state’s own pro­gram — the Healthy In­di­ana Plan — to cov­er low-in­come in­di­vidu­als who would qual­i­fy for tra­di­tion­al Medi­caid un­der the Af­ford­able Care Act’s Medi­caid ex­pan­sion.

But he wants to make his op­pos­i­tion to the health law — and com­mit­ment to re­peal — very clear.

“Obama­care needs to be re­pealed for many reas­ons, in­clud­ing that it is push­ing a massive, flawed Medi­caid pro­gram onto states,” Pence said at an Amer­ic­an En­ter­prise In­sti­tute event Monday. Once Obama­care is re­pealed, [In­di­ana’s] con­sumer-driv­en plan will serve as a mod­el for what block-gran­ted Medi­caid pro­grams can be in states across the coun­try.”

Obama­care calls for the ex­pan­sion of Medi­caid cov­er­age to all in­di­vidu­als be­low 138 per­cent of the fed­er­al poverty level, but the Su­preme Court left the de­cision to the states. Twenty-six states plus D.C. have op­ted in­to ex­pan­sion, but a hand­ful of red states have re­frained, in protest against the en­ti­tle­ment pro­gram and the health care law.

Re­pub­lic­an gov­ernors have found them­selves in sticky ter­rit­ory — want­ing to avoid a cov­er­age gap in their state, but more vehe­mently want­ing to avoid giv­ing their im­pli­cit stamp of ap­prov­al to Obama­care.

Some, like Pence, have tried to find work­arounds that would take the fed­er­al fund­ing and ex­pand cov­er­age to low-in­come res­id­ents, but through a private, mar­ket-based ap­proach that is more pal­at­able to Re­pub­lic­ans. Arkan­sas led the way with its “private op­tion” plan, and oth­ers, such as Pennsylvania and In­di­ana, have fol­lowed suit.

The In­di­ana al­tern­at­ive — HIP 2.0 — would ex­pand on the ex­ist­ing state pro­gram, and in­clude three dif­fer­ent plan op­tions: HIP Link, HIP Plus, and HIP Ba­sic. All in­clude a Per­son­al Well­ness and Re­spons­ib­il­ity, or POWER, ac­count that is in­ten­ded to func­tion like a Health Sav­ings Ac­count; re­quire a con­tri­bu­tion from the pa­tient; and em­phas­ize pre­ven­tion, with a pen­alty for un­ne­ces­sary emer­gency-room use. They are in­ten­ded to be tem­por­ary plans, un­til con­sumers are able to work their way up to trans­ition in­to the private in­sur­ance mar­ket­place, Pence says.

HIP Link is a premi­um as­sist­ance pro­gram for people with ac­cess to em­ploy­er-based cov­er­age but who may not be able to af­ford the plans. HIP Plus is for in­di­vidu­als be­low 138 per­cent of the fed­er­al poverty level who make their POWER con­tri­bu­tions, while HIP Ba­sic is for those be­low 100 per­cent FPL who do not make their re­quired con­tri­bu­tions. HIP ba­sic in­cludes a less com­pre­hens­ive be­ne­fits pack­age and pre­scrip­tion-drug be­ne­fit. Those above 100 per­cent FPL risk los­ing their cov­er­age en­tirely if they don’t make their con­tri­bu­tion; those be­low 100 per­cent must make co-pays and re­ceive few­er be­ne­fits un­til they are able to con­trib­ute again.

Pence in­sists that his pro­posed ex­pan­sion of the Healthy In­di­ana Plan is not Medi­caid ex­pan­sion, and is not Obama­care. But he is seek­ing to pay for the pro­gram us­ing Obama­care dol­lars, even as he con­tin­ues to call for the law’s re­peal.

Of course, if Obama­care were re­pealed, Pence would not have the fund­ing he seeks to im­ple­ment HIP 2.0.

The In­di­ana pro­pos­al is cur­rently in the com­ment peri­od, and Pence plans to sub­mit the waiver ap­plic­a­tion to CMS some­time next month. The fed­er­al gov­ern­ment will need to ap­prove the re­quest in or­der for the plan to move for­ward.

“We haven’t shaken hands on this deal yet,” Pence said. “But I’m hope­ful.”

What We're Following See More »
STAFF PICKS
After Wikileaks Hack, DNC Staffers Stared Using ‘Snowden-Approved’ App
11 hours ago
WHY WE CARE

The Signal app is fast becoming the new favorite among those who are obsessed with the security and untraceabilty of their messaging. Just ask the Democratic National Committee. Or Edward Snowden. As Vanity Fair reports, before news ever broke that the DNC's servers had been hacked, word went out among the organization that the word "Trump" should never be used in their emails, lest it attract hackers' attention. Not long after, all Trump-related messages, especially disparaging ones, would need to be encrypted via the Snowden-approved Signal.

Source:
PROCEDURES NOT FOLLOWED
Trump Not on Ballot in Minnesota
4 days ago
THE LATEST
MOB RULE?
Trump on Immigration: ‘I Don’t Know, You Tell Me’
4 days ago
THE LATEST

Perhaps Donald Trump can take a plebiscite to solve this whole messy immigration thing. At a Fox News town hall with Sean Hannity last night, Trump essentially admitted he's "stumped," turning to the audience and asking: “Can we go through a process or do you think they have to get out? Tell me, I mean, I don’t know, you tell me.”

Source:
BIG CHANGE FROM WHEN HE SELF-FINANCED
Trump Enriching His Businesses with Donor Money
6 days ago
WHY WE CARE

Donald Trump "nearly quintupled the monthly rent his presidential campaign pays for its headquarters at Trump Tower to $169,758 in July, when he was raising funds from donors, compared with March, when he was self-funding his campaign." A campaign spokesman "said the increased office space was needed to accommodate an anticipated increase in employees," but the campaign's paid staff has actually dipped by about 25 since March. The campaign has also paid his golf courses and restaurants about $260,000 since mid-May.

Source:
QUESTIONS OVER IMMIGRATION POLICY
Trump Cancels Rallies
6 days ago
THE LATEST

Donald Trump probably isn't taking seriously John Oliver's suggestion that he quit the race. But he has canceled or rescheduled rallies amid questions over his stance on immigration. Trump rescheduled a speech on the topic that he was set to give later this week. Plus, he's also nixed planned rallies in Oregon and Las Vegas this month.

Source:
×