A Citizen's Guide to Indiana

Maureen Groppe, writing for Gannett, has a story entitled “Report: Big Drop in Uninsured if Indiana Expands Medicaid.”

To recap, part of the healthcare reform effort was to expand Medicaid eligibility for people up to 138% of the poverty level (that’s roughly $27,000 for a family of three according to the news article). Originally, the expansion was more or less mandatory; but the Supreme Court said it had to be discretionary, state by state. Gov. Pence never liked the idea of health care reform and, one gets the sense that his opposition is as much political as it is policy-driven. And, so, Indiana is exercising its discretion not to expand Medicaid. Instead, as a fig leaf of sorts, Indiana is attempting to have the feds endorse the state’s Healthy Indiana plan as a Medicaid expansion substitute.

“Gov. Pence has made clear to Secretary Sebelius that any discussion on a potential coverage increase must start with the Healthy Indiana Plan,” Pence spokeswoman Kara Brooks said Wednesday. “As our current waiver expires at the end of this year, the first priority is to secure an extension of the current program.”

(“Must” — the feds love it when you try to dictate terms to them.) In any event the Healthy Indiana plan covers 37,000 with 53,000 on a waiting list. The Medicaid expansion, funded mostly by the federal government, would insure 400,000. According to the Kaiser Commission report cited by Ms. Groppe, the number of uninsured Hoosiers would be cut in half; reducing the state’s non-elderly, uninsured population from 17% to 8%.

Also, according to Aaron Carroll, aside from not covering as many people, the Healthy Indiana plan costs Indiana more than Medicaid expansion would. A lot more:

Indiana will save a lot of money by allowing the expansion to occur. In 2009, it’s estimated that we spent more than $150 million on the Healthy Indiana Plan. This would no longer be needed, as many would transition into either the Medicaid expansion or the private insurance exchanges. We spent $15 million on our high risk pool plan, which would no longer be needed, as those people would get insurance elsewhere, too. We spent more than $12 million on local tax credits for businesses buying insurance which would no longer be needed as they are replaced by federal tax credits. We spent more than $125 million on uncompensated care for the indigent which would no longer be needed, as far fewer people would be uninsured. And, finally, there was a hidden tax of almost $30 million put on Hoosiers to pay for uninsured care for others through cost shifting and higher premiums. This, too, would go away. We may even be able to save more money if we petition HHS to allow us to transition some children and families from CHIP to the exchanges. But even without that, if you add all the spending I just laid out together, Indiana could have saved more than $335 million in 2009 alone, compared to the $63 million the expansion would have cost if Indiana had covered 10% that year. The savings would more than pay for the costs of the expansion moving forward.

Let’s get back to basics. The rest of the industrialized world has figured this out. They provide health care to their people; they do it for less money; and they get similar if not better outcomes. We could do this too if we wanted to; we’re just reluctant to do so.

Scott Tibbs, at Hoosier Access, has a post about public meeting times that I wanted to flag, not so much to single out Scott, but to address this notion I hear occasionally about changing public meeting times to allow for participation by the public.

The state legislature should start by making it illegal for any local government elected body to meet before 6:00 p.m. Ideally, this should apply to boards and commissions as well, but the first priority should be to enable more public scrutiny of elected officials as they decide budgets and legislation. This does not need to be implemented immediately, as local government can be given a couple years to change their schedules to allow for more public participation.

The idea is that people will be more likely to go to these meetings if they are not during traditional work hours. It’s plausible on its face, but, in my experience, later meeting times do not result in a notable increase in public attendance of meetings. In addition, because you are holding these meetings after hours, the unit of government faces increased costs associated with employees working longer hours and keeping public buildings open later than usual. Finally, I tend to oppose the State telling local government how to run its business.

I’m not at all against the units of local government accommodating public interest. Sometimes there are issues that are contentious or capture the popular imagination; and where there is a great deal of public input to be had, the meetings should be held at times and places that are convenient to public input. But the truth is that the public, by and large, has little interest in the minutiae of government work; and has neither the time nor the inclination to investigate the details on most issues. The result of a mandatory post-6 p.m. meeting requirement would generally be empty meeting rooms, later at night.

I would suggest that, if work hours are a barrier to public participation in government, we start by expanding election hours or moving election days into times that are not traditional work hours. If that yields greater participation, maybe it would be time for serious consideration of a state mandate for moving meeting times.

The Urbanophile has a post that Libertarians can surely get on board with. He takes a swipe at the narrative of the fiscally conservative Republican governor. He argues generally that they’re no more frugal than their Democratic counterparts.

In particular, he takes aim at Ohio’s Governor Kasich who defunded Cincinnati’s plans to invest in street cars only to start spending piles of money on a bypass around the small town of Portsmouth, Ohio. On the way, he notes similar behavior by Indiana Governors Pence and Daniels for Indiana’s plan to spend $100,000 per foot on a highway in Kentucky.

Today was the 9th Annual Legal Aid golf outing fund raiser for Tippecanoe County Legal Aid. I’ve been involved all nine years in one capacity or another, and this was the best one so far. This year, I was a member of a three person committee that pretty well organized the entire thing. There were something like 72 players and 34 sponsors; of which 1st Source Bank was the major one. My rough estimate is that we raised about $10k – $12k for Legal Aid which is an organization that provides free legal help to low income individuals in non-criminal, non-fee generating cases. (The government pays for lawyers for criminal cases; and, for fee generating cases, you can usually find a lawyer to take it on contingency.) A lot of the cases the Legal Aid attorneys handle are things like “Child In Need of Services” (CHINS) cases where you might have parental rights at stake — no money in it; not criminal; but a very important situation where you probably need a lawyer to help you out.

Organizing the event isn’t a huge undertaking. But, it’s not nothing either. My theory is that if all of a community’s citizens kick in a little bit of community oriented effort; the place is probably going to do o.k. In my case, my two major contributions, in terms of time spent on community activities, end up being organizing this golf outing and coaching my kids’ soccer teams.

Obviously it’s a lot easier to volunteer time and effort when the people you have good people to work with. And, I’ve certainly been fortunate to have that be the case for me. Looks like I’m up for at least a 10th year.

Richard Longworth has a good post on Detroit. Aaron Renn also has an interesting take.

Neither of them go the cartoonish two dimensional villain route. Like Longworth points out:

Detroit’s bankruptcy has created a playing field for pundits, each of whom has a preferred villain (Democrats, car companies, unions, globalization, feckless government, heedless suburbs, the black politicians who ran the city, the white residents who fled it). All guilty as charged, and then some.

And Renn points out:

What’s most surprising about Detroit’s bankruptcy is not that it happened, but how long it took to get there. In authorizing the bankruptcy filing Gov. Rick Snyder talked about “60 years of decline.” He’s not joking. It’s been widely known that Detroit has been in trouble for a very long time.

It remains to be seen whether the bankruptcy represents rock bottom for Detroit or just a step along the continuing path to decline. A lot of that is going to depend on whether it can come up with a new economic raison d’etre. Because manufacturing cars is no longer sufficient.

The New York Times has a demographic map showing that it’s tougher for people from the bottom quintile to rise to the top quintile in Indiana, Ohio, Michigan, and the Old Confederate States.

In large swaths of those states, a kid born in the bottom twenty percent has a 4% chance of rising to the top twenty percent. I expect North Dakota’s shale boom combined with relatively low income disparity and sparse population allows that number to rise from 4% to 35%. In most areas, it seems more like 15%.

Climbing the income ladder occurs less often in the Southeast and industrial Midwest, the data shows, with the odds notably low in Atlanta, Charlotte, Memphis, Raleigh, Indianapolis, Cincinnati and Columbus. By contrast, some of the highest rates occur in the Northeast, Great Plains and West, including in New York, Boston, Salt Lake City, Pittsburgh, Seattle and large swaths of California and Minnesota.
. . .
That variation does not stem simply from the fact that some areas have higher average incomes: upward mobility rates, Mr. Hendren added, often differ sharply in areas where average income is similar, like Atlanta and Seattle.

The gaps can be stark. On average, fairly poor children in Seattle — those who grew up in the 25th percentile of the national income distribution — do as well financially when they grow up as middle-class children — those who grew up at the 50th percentile — from Atlanta.