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Plan HIP for too few

Debra Minott, secretary of Indiana’s Family and Social Services Administration, recently was moved to write a defense of the state’s approach to health insurance. Though her comments were directed at The Indianapolis Star, they could easily apply to some of our articles and editorials, and we’re presenting it on today’s Opinion page.

Minott’s high opinion of the Healthy Indiana Plan as an alternative to Obamacare is not surprising. The administration expressed that preference pretty clearly when it opted to operate its own health care marketplace and to forgo the option of extending Medicaid to Hoosiers who make too much to qualify currently or too little to qualify for tax-credited enrollment in an Obamacare health plan.

The “strategic and thoughtful effort by the Pence administration to make sure more Hoosiers had a coverage option on Jan. 1” Minott describes threatens to leave many Hoosiers in health care limbo.

On this issue, exact numbers are hard to come by, and it may be tempting to simply defer to Minott as the person in the know. She says “20,000 more low-income Hoosiers will have health care coverage in 2014.”

But there are other numbers to consider. The Henry J. Kaiser Family Foundation offers what appears to be a fairly conservative estimate of how many Hoosiers will be left in the no-coverage zone by Indiana’s decision to stick with HIP: 182,000.

As part of the “agreement” in which the Pence administration spurned the Obama administration’s offer to fully implement Obamacare in Indiana, the income threshold to qualify for HIP was lowered by half. That means some 10,000 Hoosiers will be dropped next month, and it appears many of them will not qualify for a marketplace plan tax credit, so that overall number might even go up.

But even if not, Minott’s estimate would leave 162,000 Hoosiers without coverage in January who could have been covered if the administration hadn’t been quite so “strategic and thoughtful” in its approach.

Regardless of how well the individuals who were covered liked the program, HIP has consistently failed to cover anywhere near the number of uninsured that it was supposed to cover. The goals were articulated at anywhere from 100,000 to 130,000; now, it has about 31,000 enrollees.

Also, the source of disagreement between the state and federal governments is the fee that HIP enrollees must pay to help set up their health-management account. To Pence, this fee ensures buy-in by the patients and helps ensure that they take some responsibility for their own health and health care.

While responding to an emailed question about the numbers Friday, Minott emphasized the ideological tussle is not over.

“We continue our discussions with CMS (the federal Centers for Medicare and Medicaid Services) regarding a full expansion using the key design elements of the Healthy Indiana Plan,” she wrote.

The discussions should be over. Indiana should drop its objections to Medicaid expansion and get those thousands of folks signed up.

Worrying about buy-in and responsibility is fine. But we’re talking about real people who Indiana needs to get covered now .