Daniels says legislators to decide Medicaid change

Gov. Mitch Daniels chided President Barack Obama's health care law as "dangerously misguided" Thursday, but sidestepped the question of whether Indiana should continue resisting its implementation after the U.S. Supreme Court's landmark decision finding the law constitutional.

The Republican governor's tone was muted during an impromptu news conference at the Statehouse, one week after he was named the next president at Purdue University and pledged to refrain from political statements. He said the next step would likely be up to the Legislature and his successor as governor, who won't take office until January.

Daniels said he wants to make sure he understands the mixed, 5-4 ruling, particularly the sections that deal with the law's Medicaid expansion to cover people up to 133 percent of poverty level, and the establishment of online marketplaces for patients to shop for insurance policies.

"If it's optional as I'm advised that it is, that'll be a decision for future legislators to make," Daniels told reporters. "It's a $2 billion-plus cost to do what the federal government tried to order Indiana to do. So that's a big decision."

Later in the day, his staff released a more sharply worded statement critical of the law, but even it offered little insight into what Daniels believes should be done next. He predicted the law would drive up premiums for individual insurance by as much as 95 percent and increase deficits and the national debt, which he has characterized in a book as a "red menace."

"The court's ruling that the federal government has the constitutional power to do what it has done must be respected. But many actions that are constitutional are still unwise," he said.

The state must decide by Nov. 16 whether to operate its own marketplace, let the federal government do it, or form a partnership with the federal government. Operating a state online insurance market, or exchange, could cost $50 million to $65 million in the first several years of operation, Daniels' statement said.

The court found problems with the Medicaid expansion but said it could proceed as long as the federal government does not threaten to withhold states' entire Medicaid allotment if they don't take part in the law's extension.

But he didn't call the health care overhaul socialism, as other conservatives have done.

Daniels' gentle touch may possibly have been a result of his June 21 pledge to refrain from political commentary for the remainder of his final term as governor. "Effective immediately, I will recuse myself from any partisan political activities or commentary," he said in a speech when Purdue trustees introduced him as the university's next president.

But some Indiana lawmakers apparently agreed with Daniels when he said the next step was up to them.

"I would suspect that it would be a legislative decision," said Rep. Charlie Brown of Gary, the top Democrat on the House Public Health Committee.

Asked if he thought Republicans who control the General Assembly would go along with a Medicaid expansion, Brown replied: "We have to remove the politics from it and look at what's good for Indiana."

But Indiana Senate President Pro Tem David Long, R-Fort Wayne, said the state would "certainly" opt out of the Medicaid expansion, which he said would have meant an inevitable tax increase.

"Now, Hoosiers can avoid such a tax increase by the state opting out of Obamacare's Medicaid mandate, which we will certainly do," Long said in a statement.

Indiana had proposed to use its medical savings account program, the Healthy Indiana Plan, to help cover the half-million people who will become eligible for Medicaid in 2014, but the Centers for Medicare and Medicaid Services in September said the proposal was premature. The state runs HIP under a Medicaid waiver that is set to expire at the end of 2012.

Daniels said he wasn't sure if the ruling meant the state could proceed with its plans for HIP, which he called a success.

Daniels said he doubted that a special legislative session would be necessary to handle the state's response to the health care overhaul now that it's been upheld, but qualified that by saying that he "wouldn't rule anything in or out."

Republican gubernatorial candidate U.S. Rep. Mike Pence said the ruling meant it was now up to Congress to repeal the overhaul, while the spokesman for his Democratic opponent, John Gregg, said the health care law would benefit Hoosiers.

"Congress must act immediately to fully repeal ObamaCare and protect Hoosier families, small businesses and family farms from its tax increases and mandates," Pence said in a statement. "If ObamaCare is not repealed in full, Hoosiers will face higher health care costs and increased taxes."

Gregg campaign spokesman, Daniel Altman, said Gregg, a cancer survivor, knew the burden of health care costs firsthand.

"As governor, John will bring Indiana patients, physicians, stakeholders and insurance companies together to discuss how to implement this law in the most cost effective and consumer friendly way for Indiana while also focusing on important issues like preventative health care and wellness that can lower health care costs for all Hoosiers," Altman said.Indiana Gov. Mitch Daniels says he wants to make sure he understands the Supreme Court ruling upholding the health care law before deciding how the state will respond.