A decade ago, Denise Breeden-Ost didn’t know if she would call an ambulance in the event of an emergency.
“If you can drive the person to the hospital yourself, you don’t have to pay for the ambulance service,” she said. “Sometimes in that situation you do need an ambulance, yet you are thinking, ‘Maybe I can deal with this on my own.’”
Back then, Breeden-Ost and her husband were among more than 800,000 uninsured Hoosiers. Now, the couple is covered by the Healthy Indiana Plan, a health care coverage program implemented by the state in 2008 to insure eligible adults.
“Before that, I had never had health insurance — couldn’t afford it,” Breeden-Ost said. “One of the biggest differences has been being able to have my own doctor. I feel like I’m receiving health care rather than just treating urgent things.”
The Breeden-Osts make their living selling vegetables grown on their farm, Getty’s Creek Farm. They have a place to live and healthy food to eat, but they need help when it comes to affording health care, Breeden-Ost said.
And there are friends, family, neighbors who need to have the same kind of health care service available, she added.
“It really is life and death,” she said. “For me, it’s a quality of life issue, but for some people it’s more than that. We need to do what’s right.”
Chair of the Public Health Committee Rep. Ed Clere, R-New Albany, said he agrees the governor and legislature want to find responsible ways to implement wider heath care coverage for Hoosiers.
“We just can’t agree on how to do it,” he said.
Currently, HIP, created in 2007, covers about 40,000 people. Medicaid expansion, part of the Affordable Care Act, could cover an estimated 400,000 people if implemented next year.
The federal government has agreed to pay 100 percent of the Medicaid costs for the first three years, tapering down to 90 percent in 2020.
However, opponents say Medicaid is a broken program and worry the federal government won’t keep its promise to pay.
Gov. Mike Pence wants to use the federal Medicaid expansions funds for an HIP expansion instead.
The dilemma: Washington doesn’t seem keen on accepting HIP as a substitution for Medicaid.
With the state legislature closing April 29, time is running out for legislators to weigh in on the expansion.
“Washington will get back with us, but twice they’ve said they are not in favor of it,” said Rob Stone, director of Hoosiers for a Commonsense Health Plan. “It just seems to me that the federal government has shown no evidence of doing something quite this radical.”
Stone is a proponent of accepting Medicaid expansion, as all the states bordering Indiana have done.
“If we don’t get anything done, we will be an island of the uninsured,” Rep. Matt Pierce, D-Bloomington, said.
Pierce is also a proponent of taking the Medicaid expansion, but he said he believes there are political undertones that would prevent that from ever happening.
“It’s all politics,” he said. “The governor wants to run for president. It benefits the governor politically to be seen as most opposed to the (Medicaid) expansion.”
At the same time, he said, the governor and legislature “know deep down” that health care policy needs to change.
“What they can do to satisfy that feeling is the HIP plan,” he said. “If you are so in love with HIP and you can get Obama to sign off on it, that’s great. But you have to have a fallback. The question is, what’s going to happen?”
Clere said he wishes he knew the answer to that question.
Senate Bill 551, a proposal to negotiate with the federal government about the proposed HIP expansion, died in the Senate last week — and with it the legislators’ best chance of influencing the expansion.
“One of the realities of the situation is a lot of the legislation will go on through the summer,” Clere said.
He explained that some of the concerns could be addressed as the state determines its two-year budget before the legislative session ends.
He supports HIP for several reasons, he said. He likes that it’s market-based, consumer driven and fiscally conservative. But he added that he wants to seek a middle ground between HIP and Medicaid.
“There is some concern that HIP may not be approved as an expansion vehicle,” he said. “We won’t have a fallback option.”
Scott Stowers works with individuals covered by Medicaid and HIP every day.
Stowers is the regional manager for Individual Solutions, a department of IU Health that helps uninsured and under-insured clients find health coverage.
He said there are a lot of gaps in the health care system currently, and he is not sure what the state government will be able to do.
“We can only sort of speculate on what might go through, and it’s really not hopeful right now,” he said. “We need expansion. Any type of expansion we can get, it is a good thing. Without it we will still see some of the gaps for people and potentially new ones.”
For Breeden-Ost, it’s easy to understand what those affected by health care expansion might be feeling. With an income of $10,000 for a family of three, the Breeden-Osts make less than half the income of the national poverty level.
The nagging worry that always hangs over your head when you are living that way is health care, she said.
“I see that as one of the real scary things about having a low income, because usually you can’t substitute things for money when you need medical care,” she said. “If we need antibiotics or chemotherapy or blood work, there’s no way we are going to be able to pay for that with sweet potatoes.”
She said she thinks Medicaid is the best way to expand health care immediately, but she acknowledges that using HIP is the only way the state will consider expansion.
“If they can bring themselves to do it under HIP, and if the federal government can bring themselves to approve what they want to do, it’s certainly better than nothing,” she said. “It’s way, way better than nothing.”
