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November 25, 2013

HOWEY: Indiana needs a comprehensive health strategy

— Indiana needs a comprehensive, statewide health strategy.

When it comes to the relative health and well-being of the 6.5 million Hoosiers — collectively rated as the 41st most healthy population in the U.S. and down from 37th a few years before — there is a surplus of empathy.

Gov. Mike Pence explained, “The issue of infant mortality, the issue of childhood poverty in Indiana, are two that weigh heavy on my heart. We’re going to continue to assemble the information and identify” solutions.

There is the policy debris field we know as the Affordable Care Act, or Obamacare, that has muddled and obfuscated a clear path forward. On Monday, House Speaker Brian Bosma observed, “Rarely can you use ‘fiasco’ or ‘debacle’ with respect to government action. You might disagree with it, but the ACA is now a fiasco and a debacle.”

And there is a recognition that if Obamacare collapses — and it is far too early to make that determination — it will mean Congress and the state legislatures will enter a health policy triage.

“The fact is that we can’t afford the health care system that we had,” said House Minority Leader Scott Pelath, D-Michigan City and human resources director for the Swanson Center mental health facility. “You can’t sustain 20- to 25-percent premium increases every year. We can’t afford to keep sending people to emergency rooms as their only health care option.”

Senate President David Long explained, “Twenty-five states have done just like Indiana” in rejecting a Medicaid expansion. “If those states band together ... and say, ‘We’re going to have a plan ... I think you could have something there.”

The political reality is that the Indiana Republican Party, dubbed the “Party of Purpose” that feeds on “Hoosier Common Sense,” controls virtually all the policy levers in this state.

This emerging scenario begs for a comprehensive statewide approach in a potential three-year time frame that Obamacare establishes for a Medicaid expansion. The state has world-renowned research universities; life science, orthopedic and pharmaceutical clusters; and consumer-driven policy innovation that resulted in a post-IBM “hybrid” safety net program at FSSA to the forging of the fledgling Healthy Indiana Plan.

Asked about a potential blue ribbon commission pulling the various areas of expertise together to forge a state-based health care approach for Hoosiers, Gov. Pence reacted by saying, “I take your point that if we have the opportunity to continue to advance the kind of health insurance innovation that is in the interest of Hoosiers’ health, then I’m open to doing that.”

Pence has asked the various state agencies to assemble an array of health metrics. “There is a lot of work left,” said Pence, who governs a state where 30 of the 92 counties offer no neo- or post-natal care facilities, impacting the infant mortality rate. “Other than public safety, there is no more important work that we do than the health and well being of our people.”

The factors Indiana Republican leaders face are an aversion to any notion of a tax increase, as opposed to extending service to constituents.

Pence and Long cited the $25 million annual cost of running an Indiana-based health exchange. “My decision was based entirely on our analysis in the immediate days following my election that for the sum $25 million it would cost to operate, it would gain very little control over and above what Hoosiers would gain if the federal government operated the exchange,” Pence explained.

What the federal exchange has done is to force Hoosiers to seek coverage in a logistical cul de sac. While the Kentucky state exchange enrolled 33,561 in Medicaid and 7,011 in private insurance by mid-November, Indiana Republicans used the 701 who had successfully traversed the federal exchange as an “I-told-you-so” moment.

It begs the question for the Indiana GOP: Now what?

Bosma observed, “This debacle needs to shake out a little bit. I know there is federal money being dangled out there. I know there are people without insurance we have to address, but this needs to be thoughtful, it needs to be foresightful, we need to understand the consequences fully before we jump in.”

Long acknowledged that the “uninsured is a problem,” but said that a traditional Medicaid expansion would cost the state $2 billion. “That’s a guaranteed tax increase for everyone in this room,” he said.

This places the Indiana Republican Party at a crossroads, balancing the cost of a healthier population with the economic benefits it would bring. This is a state with a huge and growing prison population that is opposite national trends, finds citizens paying vastly higher sewer bills than previous generations because it neglected to fix the problem decades ago, and has an unhealthy population because it did not adequately invest in nutrition, early education, health care and insurance access.

Indiana policy makers are facing the same “pay me now or pay me later” dilemma.

With such a poor historical track record, the development of a comprehensive health strategy should be a compelling notion up for vigorous debate.

— Brian Howey publishes at www.howeypolitics.com. Find him on Twitter @hwypol.

 

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