News and Tribune

October 6, 2013

HAYDEN: Working poor in health care dilemma

Clere attending town hall meetings across state

By MAUREEN HAYDEN
CNHI Statehouse Bureau

INDIANAPOLIS —

Last Monday evening, as political gridlock over the Affordable Care Act was grinding the federal government to a halt, I was at a “town hall” meeting sponsored by the Indiana Minority Health Coalition, sitting with a crowd of people who just wanted help understanding how the law is supposed to work. 

As politicians in the nation’s capital competed for camera time to denounce each other for shutting down the government over the law known as Obamacare, the people I sat among politely asked for help navigating their way through the online health insurance exchange that was set to go live the next morning. 

Helping them get what they needed was Rep. Ed Clere, a New Albany Republican who chairs the House Public Health Committee and has been touring the state, attending the Coalition’s town halls. 

He’s taken a pragmatic approach to the ACA, trying to figure out what it means for the 800,000 Hoosiers who are uninsured. As he told the crowd: “Whether we like it or not, the Affordable Care Act is the law.” 

Among those in the audience was a young man enrolled in a master’s program in public health, which he’s financed with student loans on the belief that more education will help him build a better life. His dilemma: At 27, he’s too old to be covered by a parent’s health insurance plan (which Obamacare extended to age 26) but worries he has no extra money in his tight budget to afford even a basic, no-frills health insurance plan offered under the new health insurance marketplace. 

It was little comfort to him to find out that he won’t be penalized under the ACA if he doesn’t buy health insurance, because his income is so low. It was even smaller comfort to him to find out that he likely would have qualified for the Medicaid insurance program had Gov. Mike Pence opted to expand the Medicaid program in Indiana and take federal dollars provided by the ACA to pay for it.  

About 300,000 Hoosiers, like this young man, who could have enrolled in Medicaid through the new health exchange, won’t be eligible for health insurance coverage because of that decision. 

About 500,000 more Hoosiers who are uninsured will be, but they’re having to figure that out pretty much on their own. Indiana has opted out of running its own exchange, letting the federal government do the work — and take the heat if things go badly. As a result, Indiana has received very little money to hire staff to help the uninsured navigate their way through the insurance exchange. 

You can go to the Indiana Department of Insurance website to find a list of people, called “navigators,” who are the only ones legally allowed to help people sign up for coverage. But you’ll see scores of communities in Indiana with no navigators. It’s not easy to become one and Indiana has tacked on more requirements to qualify, above and beyond what the federal government calls for. 

During the 2013 session, as his fellow Republicans in the Statehouse were working diligently to undermine the implementation of the Affordable Care Act, Clere spent his time trying to negotiate a path under the federal law that would ensure that the uninsured working poor in Indiana would gain access to health care. He sought to amend a Senate bill, for example, with language that would require the governor to negotiate a reasonable Medicaid expansion. 

At Monday’s town hall meeting, Clere was struck by the irony of the events unfolding that evening. “It shows the divide between the political elite and the people who most need access to insurance,” he said afterwards. “People want solutions, not pointless partisanship. There are plenty of reasons to question the design and sustainability of the ACA. But those are debates for another day.” 

Maureen Hayden covers the Statehouse for the CNHI newspapers in Indiana. She can be reached at maureen.hayden@indianamediagroup.com