Gov. Pence gets federal OK for Medicaid alternative

From the Indianapolis Star today, after much quibbling with the Federal government, Pence gets permission to expand Indiana's Medicaid to a new program called Healthy Indiana Plan.

First of all, what bothers me is that the ACA is a federal law, which overrides states' rights in offering health care plans for residents, Indiana had not opted into. But that's also another discussion.

Second, Pence expanded this program under "responsibility" of making very low-income residents to pay into the Indiana system. But here is the impetus for the new program

Chase Downham, Indiana state director of Americans for Prosperity, said he agrees that Medicaid needs to be overhauled but that "should not come at the cost of expanding an already troubled entitlement program to include hundreds of thousands of able-bodied, working-aged, childless adults." "Hoosiers believe in the dignity of work and desire the prosperity that comes with a job opportunity, not more government-funded health care," Downham said.

I live in a city that has a high unemployment rate because two of the companies that had provided employment were actually shut down, tossing a large portion of people into unemployment, so it is easy to say that Hoosiers believe in the dignity of work, but it doesn't work when removing jobs from Hoosiers, that forced them into Medicaid anyway.

Also

In Indiana an estimated 350,000 fell into what was known as a coverage gap – with an income above the Medicaid cutoff but still below 100 percent of the poverty level, meaning they likely could not afford to buy insurance on the healthcare marketplace. Another 150,000 individuals, who fall between 100 and 138 percent of the federal poverty level, may have been able to purchase income on the health insurance marketplace, through some of the subsidies that the ACA provided. These individuals are now being told they must transfer to the Healthy Indiana Plan or face tax penalties. About 120,000 non-disabled Indiana residents on Medicaid will also join the Healthy Indiana Plan, as well as the 60,000 or so who already receive coverage through the program.

WHY are so many non-disabled people on Medicaid?

Those who are eligible for the plan already live at the poverty level, said Timothy Jost, a law professor at Washington and Lee University and a healthcare reform expert. People who by definition are already having trouble covering basic costs such as food and rent will struggle to make an addition payment. Instead, they may opt not to participate in the program or avoid getting care.

WHY do they live at the poverty level?

I am a Medicare and Medicaid recipient because I am a disabled person with a very qualifying condition, Multiple Sclerosis and at no time in my life before while I was working did I receive an income this low, but according to Social Security I qualified because I paid enough into the system. But, and I might caution the government officials who are determining how much some is responsible for paying into the health care tax, I know a majority of SSI people who refuse to work even though they are not disabled. So, let's address that issue, because the government is calling it entitlement, when the very people doing this consider it "playing the system".

There are things we should be willing to pay for, but I am afraid that after years of conditioning by the government to cause people to believe they have the government to rely on, to then making them pay into health care, it won't work.

And here is why

Everyone enrolls at first in the HIP Plus program. But if a person whose income is 100 percent or below the federal poverty level who does not make his or her required payments will be downgraded to the Basic plan that requires co-payments for all services and limits benefits.

$1 to $27 to pay into the system or copays, have you seen the prices for copays? What is now going to regulate the cost of pharmaceuticals?

As a Medicaid recipient (not by choice but necessity), I am slowly creeping up on that wage level that will take from me the ability to have in-home health care, which I saw happen to elderly people in Indiana. Elderly people who benefitted from the past system and had necessary in-home health care suddenly had it yanked out from under them and because they could no longer afford it, because their income was just above the cut off level, were told they had to pay it out of pocket or go to a nursing home.

The policy forced disabled elderly who had paid much more longer into Social Security were suddenly no longer to be as independent before and forced into nursing homes, where the system is now taking from them their entire Social Security. Yes, it is happening in Indiana.

But how is the funding offset and why did hospitals agree with this?

The waiver comes with federal funding to pay for nearly all of the cost. The state plans to offset its $1.6 billion share with revenue from the cigarette tax and a hospital assessment fee. The expansion also includes a 25 percent increase in reimbursement for current Medicaid providers to near Medicare rates in an attempt to improve access.

So now, hospitals will no longer pay for charity cases, because every Indiana resident is presumed to want to have access to Healthy Indiana, however, neither Pence nor his advisers really know the minds of the common people.

My wife has a cousin here in indiana that has a heart condition And he is having a heck of a time trying to get on disability and Medicaid. But as you said, I see many folks on these social plans that can work.
I will be watching how this all plays out.

Hoosierdaddy, I was lucky, I lived in North Carolina when my neurologist had to gently but forcefully request I go onto Social Security. It was not an easy reached conclusion for me.

But yes, I have heard that what you are saying, there are many people who are finding it difficult to get that necessary medical care. And I will say this, all this forced insurance does not lead to better medical care.

Now, the question that confuses me the most in the article...

may have been able to purchase income on the health insurance marketplace

How does one purchase income?