HIP Replacement 2.0, or 'Onward with Healthcare Expansion'

By Rob Stone, M.D.
The Herald-Times (Bloomington, Ind.), June 30, 2014

Grassroots activists across the state, including Bloomington-based Hoosiers for a Commonsense Health Plan, have been working for the past 20 months to build support for the expansion of Medicaid to low-income Hoosiers under the Affordable Care Act (ACA). Our goal is now in reach. Gov. Mike Pence unveiled his new version of the Healthy Indiana Plan, dubbed HIP 2.0, and it appears that it may accomplish exactly what we have been asking for — coverage for 300,000 to 450,000 Hoosiers currently without health insurance.

The public comment period has now closed and the formal application will be submitted to Health and Human Services by the end of the month. Coverage will begin some time in 2015.

We are proud of all we have done. Working with a broad coalition, Cover Indiana, we delivered over 10,000 petition signatures to the governor on Feb. 19, just before he traveled to Washington D.C. to meet with Secretary Sebelius, along with a letter signed by bishops and other religious leaders around the state, and copies of city and county council resolutions (including Bloomington’s) calling for Medicaid expansion. We provided all that information to Secretary Sibelius too. Newspapers across the state printed our letters and op-eds. Legislators and the governor heard our message.

Listen to the language Gov. Pence is using:

“I have long believed that a society may be judged not only by how it deals with its most vulnerable, but also by how it comes alongside those often forgotten working people who are striving every day for a better life.”

“Low-income, working Hoosiers ... lack access to the kind of quality health insurance that their better-off neighbors enjoy. Many Hoosiers ... cannot access affordable coverage and live in uncertainty.”

“Hoosiers have long-cherished the principle that we must ‘love our neighbor as ourselves;’ that we must not ‘walk by on the opposite side of the road’ when our neighbors are hurting and in need.”

In these words, there is an implicit understanding of the failure of our current system to meet the needs of too many, and an acknowledgement that government must take a larger role in guaranteeing access to healthcare.

The governor has made many statements about market-based reforms and he claims that HIP 2.0 is anything but Medicaid expansion under the ACA. We recognize the political reality of his position, but can only praise him for the political courage he has shown. Ultra-conservatives have lambasted HIP 2.0, asserting that it “isn’t consumer driven in any meaningful sense” (The Federalist) and, “is a Medicaid expansion with some free-market window dressing.” (Forbes).

Be that as it may, if HIP 2.0 goes into effect next year as proposed, it will be the largest expansion of health insurance coverage in Indiana since the passage of Medicare and Medicaid in 1965. 

Our work is not done. Medicaid by whatever name is a flawed program, and the ACA is only a step on the way to the ultimate goal, expanded and improved Medicare for all. Everybody in; nobody out.

Robert Stone, M.D., is director of Hoosiers for a Common Sense Health Plan.