Surveys suggest it will be a long time before America falls in love with Obamacare. But there are indications that the act is accomplishing what it set out to do: cut health care costs and make health care available to more people.
Some of those benefits, though, will be slower to arrive in Indiana.
The Gallup Poll reported this week that in months since the mega-law began to be implemented, the percentage of uninsured Americans dropped from 18 percent to 13.4 percent.
But that percentage dropped a lot more in some states than in others. According to National Public Radio, the 10 states with the biggest drops all had been among those that accepted Medicaid expansion and established their own healthcare marketplace exchange or a state-federal partnership. Our neighbor to the south, Kentucky, was No. 2, with an 8.5 percent decline in the number of uninsured.
North of the Ohio River, though, things were different. Last year, when Kentucky was still setting up its aggressive, state-run online signup program, Indiana's percentage of uninsured (15.3) was actually lower than Kentucky's (20.4). But reflecting Gov. Mike Pence's often-stated antipathy toward Obamacare, Indiana declined to participate in Medicaid expansion or to run its own Obamacare registration campaign.
At the end of June, Kentucky's uninsured had dropped to 11.9 percent, while Indiana's had only declined to 15.0 – a tiny three-tenths of a percent. Only a handful of states had lower reductions than Indiana.
Indiana now is waiting for the federal government to rule on its request for a “consumer-driven” alternative to Medicaid expansion – Healthy Indiana Plan 2.0. It's a sound plan that could get the job done. But the future health care of at least 350,000 Hoosiers hangs in the balance.
It's easy to forget that the state health care industry, as well as its patients, has a compelling interest in seeing HIP 2.0 get up and running.
Brian Tabor, vice president of government relations for the Indiana Hospital Association, points out that Obamacare provided for a drop in Medicare reimbursement rates to hospitals. The idea was that the lost revenue would be replaced by new revenue from those who became newly insured through Medicaid expansion and Obamacare signups. But that hasn't happened in Indiana, and won't until HIP 2.0 is up and running.
Expanded coverage was “something that hospitals were counting on, really depending on,” Tabor said. “The reductions actually began in 2010 and increase every year,” Tabor said in an interview last week. “That's why it's an urgent matter for us.”
In fact, Tabor said, “the issue of coverage expansion is one of ultimate survival for a number of hospitals around the state.”
The state's hospitals played a key role in making the HIP 2.0 plan palatable to conservatives by agreeing to let the state increase their assessments to help pay for the plan.
With those funds and money from the tobacco tax, Pence's plan will not affect the state budget – though the plan depends on billions of dollars annually from the federal government.
The hospital association, like the governor's office, is optimistic about federal approval. The process was delayed this week when the Centers for Medicare and Medicaid Services returned Indiana's application because it hadn't held tribal consultations with the Pokagon Band of the Potawatomi Indians. A spokesman quickly reported the state is going out to get the tribe's feedback.
Let us hope this doesn't turn into a long, bureaucratic struggle. Every day that goes by before HIP 2.0 is approved may translate into another day that federal revenue flowing into other states' hospitals is not flowing into ours.
And of course it means another day that thousands and thousands of people who would have been insured if they lived in other states are not being insured because they live in Indiana.