The Slatest

Republican Indiana Governor Accepts Obamacare Medicaid Expansion, With Caveats

Mike Pence with Obama in October 2014.

Nicholas Kamm/AFP/Reuters

An estimated 358,000 uninsured Indiana residents will be covered via Affordable Care Act Medicaid expansion funds under a program agreed to by the Obama administration and the state’s Republican governor, Mike Pence. Indiana becomes the 28th state to accept the expansion and the fifth Republican-run state (joining Arkansas, Iowa, Michigan, and Pennsylvania) to have negotiated an expansion plan designed by conservatives to emphasize personal responsibility and choice. Here’s the Washington Post’s description of Indiana’s scheme, which involves personal health savings accounts:

The plan allows monthly contributions from poor adults below the poverty line, but they don’t face the risk of losing coverage for not contributing to their health savings account — anywhere between $1 and $20 per month, depending on income. Instead, they’ll be placed into a “basic” coverage program that comes with co-payments for health-care services, but their contribution is capped at 5 percent of family income, according to the federal Centers for Medicare and Medicaid Services. The basic plan also includes coverage all benefits required by the ACA, but only enrollees paying monthly into their accounts receive vision and dental coverage.

Enrollees earning above the federal poverty line can be locked out from the program for six months if they don’t pay monthly contributions, ranging from $20 to $27. Individuals will also face co-pays for unnecessary use of the emergency room ($8 for the first trip and $25 for each time after). The plan also links enrollees to job search and training programs.

If you think that sounds complicated, you’re not alone—as the New Republic writes, the Republican Medicaid plans have been criticized for being too complex and creating needless administrative costs. Other conservative-backed expansion programs, nonetheless, are already being negotiated in Tennessee, Utah, and Wyoming and are being considered in a number of other states.