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It’s HIP to be responsive

Pence also has ‘skin in the game,’ so now he must deliver

I am a licensed clinical social worker with 30 years of experience in health care and mental health.

I support Gov. Mike Pence’s’ proposed expansion of health care accessibility by proposing HIP 2.0 as a replacement to the expansion of Medicaid in Indiana under Obamacare However, I approve with some reservation.

Since the governor has chosen the Family and Social Services Administration to manage and administer HIP 2.0, through the Department of Child Services/Division of Family Resources, many systemic changes must occur for HIP 2.0 to bring meaningful change.

The governor has said, “I have long believed that a society may be judged not only by how it deals with its most vulnerable, but also by how it comes along side those often-forgotten working people striving for a better life.”

The governor has also said, “Hoosiers have long cherished the principle that we must ‘love our neighbor as we love ourselves’; that we must not walk by on the opposite side of the road when neighbors are hurting and in need.”

The governor has the opportunity to put his words into action. Indiana has already wasted a year of the opportunity for better health for those in need by refusing to expand Medicaid in this state. I personally am opposed to the provision of the two-tiered system designed to punish HIP 2.0 enrollees who miss one payment.

Available benefits for vision and dental services would be eliminated for a year until the applicant could show he is a “responsible” payer into the power account.

Denying important health care access should not be a “cherished principle” of HIP 2.0. Vision and dental care are part of our present Medicaid system, and there should be no reduction in availability in HIP 2.0.

Both vision and dental are needed health care services and not to be used as some bargaining chip. Health and Human Services cannot support less than current Medicaid offers.

The governor demands that citizens to whom HIP 2.0 will be available must have some “skin in the game,” pay more for their own health insurance, so that each will make more responsible health care decisions. I believe “skin in the game” may be a poker term, a gambling term related to risk. With the implementation of HIP 2.0, the governor is in the game, and must play his hand well for the Hoosiers he represents. FSSA, the state agency that administers current Medicaid and HIP, must drastically change.

HIP 2.0 cannot be another “smoke and mirrors show,” as was the privatization of Medicaid under the Daniels administration. Fred Gilbert, a retired social worker with years of experience at FSSA, referred to the privatization of Medicaid as a “train wreck,” and that is an apt description. Medicaid as administered today because of that privatization is cumbersome, confusing and fraught with mistakes made at the state level, without any help at the local level to remedy problems.

Yes, the cost of Medicaid in Indiana did decrease under Gov. Mitch Daniels, but so did responsibility, accessibility, effectiveness and efficiency of the administration of Medicaid.

Therefore, taxpayers paid for a service to citizens that was not properly delivered.

The present system continues to be fraught with problems. It is true that many physicians refuse to accept Medicaid not only because it is a poor payer to the physician, but also because it is overladen with bureaucracy and paperwork that Daniels and FSSA designed in the privatized model to “increase enrollee responsibility” but actually did much to impede access.

Gilbert and Mary Haupert, chief executive officer of the nonprofit Neighborhood Health Clinic, have given excellent recommendations for implementation of HIP 2.0. The enrollment, the implementation, including contributing to the power account, must become more localized.

There must be local caseworkers available to assist, or HIP 2.0 enrollees will be “the forgotten working people” and will be left by “on the opposite side of the road” as the state walks by.

Gov. Pence must listen to people in the field with experience and knowledge. HIP 2.0 must have an important local component. HIP 2.0 enrollees cannot lose vision and dental if one payment is missed. Efforts by local FSSA/DCS workers must be made to assist those people with payment plans. Gilbert is not sure that HIP 2.0 can be appropriately administered without systemic changes and with local management, delivery of service and connection with each enrollee. HIP 2.0 must be effective, efficient, accessible, and responsive to the citizens of Indiana.

“Hoosiers have a long cherished principle that we must ‘love our neighbor as we love ourselves’,” Pence has said. Now it is time for the governor to show his love to the people of Indiana, the enrollees in HIP 2.0, by directing that good be done for those in need and for taxpayers who expect the delivery of excellent service by the state.

Edith Kenna is with Hoosiers for a Commonsense Health Plan. She wrote this for The Journal Gazette.

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