Consider it the conservative movement’s Charlie Sheen moment.
Some conservative think tank types have quietly complained that
Indiana Governor Mitch Daniels and President Obama are on the same
road to government run healthcare, albeit at different speeds. This
whisper has erupted into a Tiger Blood rant by the Cato Institute’s
Michael Cannon entitled:
“Mitch Daniels’s Obamacare
Problem: His state’s
health-care plan promotes dependence on government.”
Cannon asserts the Healthy
Indiana Plan (HIP), which uses a mix of Medicaid funding, tobacco
taxes, and individual contributions to provide medical insurance to
working class Hoosiers, is no different than
Obamacare:
Like Obama, Daniels increased cigarette taxes to expand
government-run health care.
Whereas Obamacare requires states to open their Medicaid programs
to families of four earning $31,000 (138 percent of the federal
poverty level), Daniels expanded Indiana’s Medicaid program to
families of four earning $44,000 (200 percent of poverty). From
2008 to 2010, Indiana’s Medicaid enrollment spiked: Adult
enrollments grew 21 percent, a rate nearly double the national
average.
In his effort to paint HIP as a source of government
dependence, Cannon misstates much. First, Indiana does not
have a Medicaid program for families up to 200 percent of poverty.
HIP provides families up to 200 percent of poverty to obtain
private health insurance if their employer doesn’t offer coverage
or if they have been uninsured for 6 months or more. Participants
must pay premiums of up to about $100 a month and contribute up to
$1100 into a “Personal Wellness and Responsibility” (POWER)
Account. POWER accounts are used to pay for deductibles.
Second, Indiana’s Medicaid enrollment did not spike 21
percent. It increased 17 percent from 2008-2010, slightly higher
than the national average of 14. 6 percent. In 2009-2010 the rate
of increase in Indiana’s adult Medicaid enrollment declined (as it
did in only 16 other states) and did so more dramatically than
most.
To establish HIP Daniels shifted authority to state
government and made personal responsibility central. Cannon claims
Daniels “made Medicaid more attractive: Under his plan, the
government hands out coverage plus something a lot like cash.” By
this logic, the 1996 welfare reform bill and Daniels’ recent
proposal to extend Indiana’s school voucher program to every family
promote big government because they both “hand out
coverage.”
Similarly Cannon has to denigrate the design and impact of
HIP to portray Daniels as Obama’s healthcare doppelganger. Cannon
is half right when claiming HIP spending was higher than expected.
Most HIP participants are older and sicker than the rest of Indiana
and have had less care to boot. Short-term per patient costs of
care were higher, at first. But after three months the average
amount spent on participants and the amount of services consumed
steadily declines.
There’s a reason for that: unlike Medicaid, HIP is not an
entitlement but a way to get well. It pays for preventive care. It
pays doctors more for treating the most vulnerable. And it rewards
staying healthy. If participants use preventive services they can
keep HIP contributions to their POWER accounts. Participants are
getting healthier, using fewer services. and saving more in their
POWER accounts.
HIP has 24,906 adults with dependent children and 20,514
other adults enrolled. It also has a waiting list of more than
40,000 childless adults. That’s not increasing dependence, it’s
unmet need. The federal government bars Indiana from enrolling more
people in HIP. Daniels asked for more control over Medicaid dollars
to expand the program. Obama said no.
Cannon might applaud the President’s action since it stops
Daniels’ socialist web from spreading. But Obama’s decision — to
force people to wait until 2014 to be forced into Medicaid to get
coverage — is causing real people real suffering.
That includes Alice Moeloa of Logansport, Indiana. Ms.
Moeloa lives on disability payments and has not had insurance for
years. She could get Medicaid only if she gave up her disability
support.
According to
Indy.com, Moeloa recently applied for HIP:
Her diabetes has caused seeping wounds in her legs, making
it difficult for her to walk. Moeloa desperately wants insurance to
visit a local wound clinic. Because Moeloa, 57, is on disability,
she can apply for Medicare in about a year and a half. But she does
not want to wait.
“Every little itty bit scratch I get on my leg, I get
infected,” she said.
Moeloa is living with the threat of having her legs
amputated. Daniels wants more control over health spending to help
her and others. President Obama stands at the doctor’s front door,
turning them away. Cannon’s effort to mobilize conservative
opposition to HIP leads to the same result. Apparently, that’s a
small price to pay for “reducing” dependence on
government.
