The deadlines for two key decisions on implementing the Affordable Care Act are approaching in the next couple of months, and Governor Mitch Daniels, whose time in office is nearing an end, says he wants the next governor to be involved.
Daniels and members of his staff sat down with each of the candidates to discuss the upcoming decisions the state must make. The governor says he was impressed by how substantive the discussions were.
"They took it very seriously, just as I hoped they would and I'm convinced we've done the right thing by deferring these calls to them," he says.
One of the decisions required of Indiana is due before the November election. The state must submit to the federal government what it wants to use for an essential health benefits package.
The package is a baseline for insurers, the minimum coverage they must offer. And it has to include provisions for at least ten services, including hospitalization, pharmacy, maternity and mental health.
GOP candidate Mike Pence and Democrat John Gregg both suggest using an already existing Indiana program. Gregg was not available for an interview, but his running mate Vi Simpson took part in the meeting with the governor and has played a significant role in developing the campaign's response. She says the existing program draws wide support.
"I think we can all agree that the Healthy Indiana Plan does a good job of providing the very minimum services and we just need to comply with the federal requirements," she says.
The Healthy Indiana Plan is a basic health insurance program for uninsured Hoosiers. Simpsons points out that HIP does not include all ten required services under the ACA and will need to be supplemented.
Libertarian Rupert Boneham supports using a private insurance plan, a basic Anthem coverage plan, but still supports HIP as an option for the state. Since the essential health benefits package must be decided before the election, Daniels says he will try to find common ground between the three ideas.
The other decision – one that will be made after the fall election – has invited far more disagreement among the candidates. It involves the type of health insurance exchange the state will use. As Indiana University law professor David Orentlicher explains, the exchange is meant to be a marketplace for consumers.
"So you wouldn't have to wade through each plan's description, you know, the hundred pages of fine print," he says. "What the exchanges would do is say, here's what's covered, here's what your deductibles are, here's what your copayments and they do it in a way you can easily compare them."
The Options For Implementation
Indiana has four options – an entirely state-run exchange, an exchange operated by a network of states, a federally-run exchange, or a federal-state hybrid model. Boneham and Gregg agree here. They say they want to see Indiana use the hybrid system. As Boneham points out, that will help share the costs.
"We, as Hoosiers, are going to stand up and take some control and some lead in our choices but encourage the federal government to put up as much money as they will to help us do this," he says.
Pence's input goes a very different direction. The 6th district congressman is deeply critical of the Affordable Care Act as a whole.
"It raises taxes on Hoosiers, it erodes Hoosier freedom and I think it will continue to stifle our recovery in this state and I don't think Indiana should participate in implementing this flawed bureaucracy," Pence says.
That echoes what Governor Daniels has said. He is not shy about his opposition to the federal law.
"My skepticism about this whole bill, about its cost, about what it's going to do to health care costs, about it throwing a lot of people out of their coverage. These things are now totally documented and there's no disagreement about them."
But Simpson says, even though Daniels has been vocal in his opposition to the ACA, his administration has still met all the deadlines and applied for all the grant money possible. Boneham says even with the possibility the law might be repealed or changed, action is required now.
"If we do nothing, that's a choice that we take and the consequences are out of our hands," Boneham says. "If we actually step up and make a choice, at least we have some control of our own destiny."
Daniels says, since the exchange does not have to be decided until after the election, he will revisit the issue with the winner as part of the overall transition process.
