Medicaid expansion in Pence’s hands after session

The question of whether Indiana will expand Medicaid is now back in Gov. Mike Pence's hands, after lawmakers wrapped up their session without mandating he expand coverage under the federal health care law or suggesting the route he should take.

Pence, however, is waiting on the federal government.

The state submitted a corrected application the Centers for Medicare and Medicaid Services April 12 that would allow the state to expand coverage to more than 400,000 residents through the state's Healthy Indiana Plan. A CMS spokeswoman said Indiana's application is still being reviewed.

"We continue to be involved in very significant discussions with officials in Washington about using a framework of the Healthy Indiana Plan to for any future expansion of Medicaid," Pence said. "My priority has been on the physical health of Hoosiers and the fiscal health of Indiana. I don't think Medicaid serves the physical health of recipients very well. It basically keeps people in emergency room care, it doesn't promote preventative medicine."

Indiana hospitals and health care providers say $10.5 billion and tens of thousands of jobs are available through the federal aid which would pour into Indiana through an expansion. But Pence, and many legislative Republicans, say they are dubious the federal government will stand by its promise of paying 90 percent of Medicaid expansion.

The cost to the state of using the Healthy Indiana Plan could top $2 billion over the next seven years. Indiana's actuary pegged the cost of using the Healthy Indiana Plan at 44 percent more than traditional Medicaid in a 2011 report and, more recently, estimated the program would cost 3 percent less than a regular expansion.

A bipartisan group of House lawmakers considered forcing the governor to expand Medicaid, while leaving the method of expansion up to him, but ran into keen opposition from conservatives and Pence himself. A Senate Republican plan, meanwhile, that would have suggested how Pence should seek an expansion, won little support in the House.

By the time lawmakers ended their 2013 session, they left the issue where it had started: in the governor's hands.

Supporters of the federal health care expansion are happy to see the state considering any expansion at this point, whether it's through a state-run program or otherwise, said David Roos, executive director of Covering Kids and Families of Indiana.

"I think the Legislature needs to be commended by looking at a number of complex issues and, at the end of the day, resisting the temptation to allow social concerns to have an undue influence upon legislative policy," Roos said.