INDIANAPOLIS — In the war over the Affordable Care Act, Indiana Gov. Mike Pence won a policy victory when the Obama administration gave him a temporary pass to continue with the Healthy Indiana Plan, a high-deductible health insurance program that covers only 37,000 low-income Hoosiers.
The reprieve came on the condition that the state continues to consider its coverage options for another 300,000 uninsured Hoosiers — mostly the working poor — who’ve been left out in the cold by Pence’s decision not to expand traditional Medicaid coverage, as 25 other states have opted to do under the ACA.
During a press conference to announce the decision, Pence called it a “victory for Hoosiers” enrolled in the program (which has a waiting list of 55,000) as reporters questioned him about other Hoosiers without health care insurance.
Pence’s response was to say there was a “broad range of services” available to uninsured Hoosiers, from public clinics to hospital charity care.
“Let’s make sure there is a distinction in the language between health insurance and health care,” he said. “Every person in this state has the ability, if they are struggling with illness, to walk into an emergency room and receive care.”
Actually, according to the Indiana Hospital Association, about 2.7 million people walk — or otherwise enter — emergency rooms in Indiana hospitals every year, many because they have no place else to go.
Pence’s call for hospitals to step up ignores the fact they’ve already stepped up. According to the Indiana Hospital Association, Indiana’s hospitals eat about $3 billion a year delivering uncompensated care to people who can’t pay their hospital bills. About $1.7 billion of that was the “charity care” that, by Indiana law, nonprofit hospitals are required to deliver.
The hospitals don’t absorb all those lost dollars. Those of us with insurance do, said Linda White, president of Deaconess Health Systems in Southwest Indiana, where one out of every four emergency room patients can’t afford to pay their medical bills.
“Those costs are shifted to the people who can pay,” White said.
“Access” to health care is in the eye of the beholder. Of Indiana’s 92 counties, 30 no longer offer access to obstetrics care, according to the Indiana Rural Health Association. It’s just too costly: Hospitals that shut down their obstetrics services found that most of their patients either had no insurance or were recipients of Medicaid, which only pays about 30 cents for every dollar’s worth of medical care delivered.
“In 30 counties, you can’t birth a baby,” said association President Don Kelso, who illustrates the problem by talking about the 70-mile stretch in West Central Indiana filled with O.B.-less counties. “Between Terre Haute and Avon, there’s no place to birth a baby.”
There are 35 critical-access hospitals located in medically underserved rural areas in Indiana; 11 of them are losing money and the rest are under considerable strain.
Pence is correct: There is a safety net for the ill and uninsured. But it’s a tattered one.
That’s what a 2012 report commissioned by the Indiana State Department of Health found. The report, authored by the Indiana Primary Care Association, looked at Indiana’s health care safety net and concluded this: “Even with these various safety net options, providing health care services to all who need it remains a challenge. Approximately 1.5 million low-income Hoosiers have inadequate access to health care services.”
“We do have access, but the health of Hoosiers is not good,” Kelso said, before listing a litany of ills that include Indiana’s high rate of diabetes, heart disease, obesity and infant mortality (which is related to lack of access to pre- and post-natal care.)
The governor’s own health commissioner, Dr. William VanNess, recently noted that an infant born in Indiana has a higher rate of dying before its first birthday than almost anywhere else in the nation. Indiana now ranks 47th out of the 50 states in infant mortality.
Kelso sees that as a signal of failure by both the health care industry and the state:
“We’re down near the bottom. We’re right down there with Mississippi and Arkansas in the number of babies that are dying. Think about that.”
— Maureen Hayden covers the Statehouse for the CNHI newspapers in Indiana. She can be reached at firstname.lastname@example.org