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August 28, 2013



After reading comments on the Affordable Care Act (ACA), it seems to me that a key area of disagreement is whether government regulation in general is or is not desirable. Hoosiers have a unique ability to compare policies stemming from government regulations with those emerging from private companies setting their own policies. This is so because Indiana, compared to states like New York, has over time refrained from regulating private insurance companies.

 The following are some key provisions of ACA: 1) insurance policies must provide free preventive care (checkups, screenings, vaccines and the like); 2) creation of insurance marketplaces to provide pools for individuals purchasing their own insurance rather than obtaining it through employers or government programs like Medicare; 3) policies must allow young adults under age 26 to remain on their parents' policies; 4) preexisting conditions must be covered; denials for this reason are prohibited and higher charges for such "preexisting conditions" as being female are prohibited; 5) policies may not be cancelled if a customer becomes ill and no lifetime care cost limits can be set; 6) insurance companies must provide rebates to customers if they spend too little on actual health care and too much on such things as advertising, claims denials, executive bonuses and shareholder profits; and 7) Medicare patients will receive rebates to offset costs when their drug expenditures fall into the donut hole.

Private insurance companies have enjoyed free reign in Indiana. The companies have not elected to adopt the items listed above on their own. One result of this is that women under age 40 in Indiana pay on average 70 percent more for insurance than men of similar age and health status — even though pregnancy is not covered. A remaining question is whether ACA will be too costly to Indiana. Governors Daniels and Pence have both resisted Medicaid expansion via AFA. Both asked for a waiver to instead use the federal money to expand the Healthy Indiana Plan. Daniel's request was denied while Pence's is pending. If denied, Indiana will lose out on federal funds that other states receive. 

— Sandra French, New Albany


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