Carroll on Medicaid Expansion

Aaron Carroll’s Testimony on the Medicaid Expansion to the Indiana General Assembly.

One of the things Indiana has to decide this year is whether to expand Medicaid to include those up to 138% of the poverty line. The Affordable Care Act reforms were designed assuming that the Medicaid expansions would happen. The Supreme Court threw a monkey wrench into that assumption by saying that the state expansions should be optional. (Seemed a bit like legislating from the bench; but given the alternatives, not necessarily the worst thing that could have happened in that ruling.) Folks above the 138% mark can get subsidies to buy insurance under the ACA. But, absent state expansion, people in the no-man’s land between the current Medicaid levels and the 138% mark will be left out in the cold.

Carroll makes an important point, which often gets lost in the noise: Medicaid is good for health. These are people’s lives. The only ones they’ll ever get. Making those lives better is one of those bleeding heart things that never really shows up in the spreadsheets. But we shouldn’t forget it. This decision will affect something like 400,000 of your fellow Hoosiers. I think that works out to something like 6% of us in that middle ground between Medicaid and subsidies.

Through 2019, Indiana pays $478 million versus the federal government’s $8.5 billion. I’m always a little leery of this talking point. It’s important because we’re going to be paying these federal tax dollars regardless; the question is whether we’ll do what’s necessary to get health care services in return. But, it leaves opponents feeling smug because they’ll ask, “yeah, but what about after 2019” as if they just caught the grifter palming the ball in a shell game. But, at the end of the day, tomorrow isn’t guaranteed and nothing in this world is certain. Other countries have been managing to provide health services to their populations for many years. We probably just have to have faith in ourselves that we can do at least as good.

Carroll argues that this will actually save us money though. In addition to the direct costs we currently incur with the Healthy Indiana Plan, we also will save in areas such as the provision of uncompensated care for the indigent and hidden expenses such as cost shifting and higher premiums caused by care provided to the uninsured.