INDIANAPOLIS—Nearly 20 governors turned away the federal funding to expand Medicaid offered under the Affordable Care Act. Their states’ opposition to Obamacare meant that tens of thousands of low-income people in their states continued to live without health insurance.
But Mike Pence, governor of Indiana, was not one of them.
After two years of negotiation, Pence in January 2015 reached an agreement with the Obama administration granting Indiana a waiver to try its own form of Medicaid expansion, called Healthy Indiana Plan (HIP) 2.0. The state would become one of the 31 that participated in the Medicaid expansion, receiving federal money through the Affordable Care Act to cover people between 100 percent and 138 percent of the federal poverty line. (Medicaid already covered a limited number of people living below the poverty line.) But it could also add its own modifications, the most salient being that participants would be required to contribute monthly fees to continue to receive access to health care.
“The good news is that Indiana is a state that bought into Obamacare,” Joan Alker, a Georgetown professor who is the executive director of the Center for Children and Families, told me. “The bad news is that Pence’s vision of coverage has a lot of barriers.”
Indiana’s Medicaid expansion, with its requirement that poor people contribute to savings accounts which are then applied to the portion of the bill that insurance covers (not the co-pay), could be a model for how the Trump administration structures health care for low-income people across the country. Its architect, Seema Verma, has been appointed head of the Centers for Medicare and Medicaid Services by the Trump administration. Trump says he wants to give states more control over how they run Medicaid, and also that he wants to push health-savings accounts similar to the ones the poor pay into in Indiana. Already, other states, including Kentucky, are appealing to the federal government to be allowed to copy parts of the Indiana plan.