I mean, we cant have incentives that are deigned to help people make smart health care choices and actually save money, not when we are trying to bankrupt the country…
I first reported on this story on my old college blog when our friend Amity Shleas wrote an article about Obama moving to kill the popular and budget saving program called HIP. Why? Well Mitch Daniels is our governor and the Obama Administration did not want such a successful program written by a popular Republican governor to get any publicity.
Indiana once again tried to save HIP by asking for a waiver and Obama once again is determined to kill the program.
Obama Administration Denies Waiver for Indiana’s Popular Medicaid Program
In 2007, under Gov. Mitch Daniels (R.), Indiana enacted the Healthy Indiana Plan, an expansion of Medicaid that used consumer-driven health plans to encourage low-income beneficiaries to take a more active role in their own care. Today, Healthy Indiana is the most innovative and successful reform of Medicaid in the history of the program. Today, we learn that the Obama Administration has rejected the state’s request to extend its federal waiver, which means that over 45,000 Indianans who get their insurance through the program are out of luck.
Medicaid, of course, is the nation’s government-run health insurance program for the poor. In theory, it’s jointly run by the federal government and the states, but in reality, any time a state wants to make the tiniest changes in its Medicaid program, it has to go hat-in-hand to the U.S. Department of Health and Human Services with a formal request for a waiver, and these waivers are usually denied.
Indiana succeeded in gaining a waiver in 2007 because it was seeking to expand Medicaid to a group of people who weren’t then eligible for the program, and because the state’s effort required no additional outlays from the federal government (the Medicaid expansion was paid for with a 44-cent increase in the state’s cigarette tax.)
Structure of Indiana’s consumer-driven Medicaid plan
Beneficiaries get a high-deductible health plan and a health savings account, called a POWER account, to which individuals must make a mandatory monthly contribution between 2 to 5 percent of income, up to $92 per month. Participants lose their coverage if they don’t make their contributions within 60 days of their due date. After making this contribution, beneficiaries have no other cost-sharing requirements (co-pays, deductibles, etc.) except for non-urgent use of emergency rooms. The state chips in $1,100, which corresponds to the size of the would-be deductible.
Those who have money remaining in their POWER accounts at the end of the year can apply the balance to the following year’s contribution requirements, if they have obtained a specified amount of preventive care: annual physical exams, pap smears and mammograms for women, cholesterol tests, flu shots, blood glucose screens, and tetanus-diphtheria screens.
“We did a lot of reading on criticism of health savings accounts,” says Seema Verma, who was the architect of the Indiana program. “One of the criticisms was that people didn’t have enough money to pay for preventive care. So we took preventive care out, made that first-dollar coverage. Also, people said that people didn’t have enough for the deductible, so we fully funded it. Then, you have to make your contribution every month, with a 60-day grace period. If you don’t make the contribution, you’re out of the program for 12 months. It’s a strong personal responsibility mechanism.”
Indiana’s Medicaid successes
The program has been, by many measures, a smashing success. “What we’re finding out is that, first of all, low-income people are just as capable as anybody else of making wise decisions when it’s their own money that they’re spending,” Mitch Daniels explains in a Heritage Foundation video. “And they’re also acting more like good consumers. They’re visiting emergency rooms less, they’re using more generic drugs, they’re asking for second opinions. And some real money is starting to accumulate in their [health savings] accounts.”
The program has been overwhelmingly popular in Indiana. There’s a large waiting list—in the tens of thousands—to enroll in Healthy Indiana; enrollment was capped in order to ensure that the program’s costs remain predictable. 90 percent of enrollees are making their required monthly contributions. “The program’s level of satisfaction is at an unheard-of 98 percent approval rating,” Verma told Kenneth Artz. Employers didn’t dump their workers onto the program, crowding others out, because you needed to be uninsured for six months in order to be eligible for it.
A 2010 study by Mathematica Policy Research found that the program dramatically increased the percentage of beneficiaries who obtained preventive care, from 39 percent in the first six months of enrollment to 59 percent after one year. Of the members who had money left in the POWER accounts at the end of the year, 71 percent met the preventive care requirement and were able to roll the balances over to the following year. (The remaining 29 percent could roll over their personal contributions, but not the state contributions to their POWER accounts.)
This is an astounding achievement, given that the biggest problem with Medicaid is the way that it ghettoizes its participants, preventing them from gaining access to routine medical and dental care. This lack of physician access is the biggest reason why health outcomes for Medicaid patients lag far behind those of individuals with private insurance, and even behind those with no insurance at all. Healthy Indiana has completely reversed this trend, achieving preventive care participation rates that are higher than the privately-insured population.