A Free Market Option for the Poor

Close up of female African American doctor holding patient’s hand

We have all heard the doomsday laments of the left claiming that “health care” will be ripped away from the sick and the poor as well as the elderly. The premise of the left side of the political spectrum is that Republicans are heartless creatures who just want to throw sick and/or poor people out onto the streets to die in the gutter.

As a conservative Christian woman, I can tell you that is totally untrue! In fact, I have a strong desire to see everyone – from the poor to the rich (because we are all human and vulnerable) – taken care of if they have medical issues.

How Do We Make Government Care for the Poor Work?

Medicaid is the government program designed to care for the medical needs of low-income people.

I discussed, in my previous post, how unsustainable the Medicaid system has become, especially because it has been expanded in many states since Obamacare became law, with several states experiencing cost overruns because the number of enrollees has outstripped projections in those states.

However, one state stands out as a model for providing health care support for the poor that is light on government intervention and provides Medicaid recipients with choices – Indiana.

One of the problems with Medicaid has been that reimbursements to doctors for patient care have been so low that they do not even cover those doctors’ costs in keeping their practices open if they are running independent practices, so they either have to limit the number of Medicaid patients they treat or they have to totally opt-out of taking those patients. So those patients may have a card to show they have Medicaid coverage, but they do not have the access to primary care physicians that they need to stay out of emergency rooms if their illnesses progress too far.

Some people would like to blame “greedy doctors,” but how is a doctor supposed to remain in practice to treat anybody if they cannot even so much as cover the cost of treating individual patients?

How can that problem be solved while taking care of the medical needs of the poor? Enter Healthy Indiana 2.0, the Medicaid program for able-bodied adults living at or near the poverty level. According to a Health Affairs Blog article entitled “Healthy Indiana is Challenging Medicaid Norms,” by Seema Verma and Brian Neale, the state of Indiana launched this newest version of the Healthy Indiana Plan (HIP) in 2015 thanks to waivers approved by the federal government.

One of the most interesting aspects of Healthy Indiana 2.0, according to this article, is that it gives able-bodied Medicaid beneficiaries the opportunity to be prudent health care consumers. These beneficiaries receive a High Deductible Health Plan (HDHP) with a $2,500 deductible, which is paired with a “POWER” account of $2,500 that is very similar to the traditional Health Savings Account. Beneficiaries in this plan use the POWER account to pay for standard medical expenses up to the point that they meet the deductible for their health plan. At that point, the health plan will kick in to pay the rest of the medical expenses for that beneficiary.

Additionally, Healthy Indiana 2.0 pays for preventive services so the money for those services does not come out of the beneficiaries’ POWER account for the deductible, and they are incentivized to make proactive health choices.

Beneficiaries in these POWER accounts are also required to pay two percent of their incomes into these accounts to be used as available cash for medical expenses.

According to the Health Affairs Blog article, the incentives and consequences outlined in Healthy Indiana 2.0 are designed to “support transition” to a commercial or employer-sponsored insurance plan.

Then, according to Martina (last name not given) at Indiana’s Medicaid phone line, Indiana still enrolls elderly, blind, and disabled people in a managed care plan called Hoosier Connect Care. So the most vulnerable people are still taken care of.

I have little bit more to say about this plan, but that is for another day. However, I leave you with this thought today – that with the unsustainability of the current Medicaid system, our leaders need to be thinking “out-of-the-box” and be prepared to really innovate.

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