OPINION: Pence, some lawmakers at odds on Medicaid expansion

Already engaged in a battle with House Speaker Brian Bosma, R-Indianapolis, and others on an income tax cut that’s received a cool reception in the Legislature, Pence spent some of his political capital last week putting the brakes on a measure that would have put an expansion into motion under certain conditions — without giving him the option to stop it.

Pence has tried hard to turn his opposition to a Medicaid expansion into a statement. His office this month sent out a news release saying he “flatly refused” to grow the program in its traditional form. The governor also earned the Wall Street Journal’s praise for comparing the idea to a “baby elephant” that the federal government would feed in its early stages, and then eventually hand over to states as a full-grown animal with a huge appetite.

Meanwhile, a group of moderate legislative Republicans — especially those who represent communities in which hospitals are key economic drivers — were swayed by the 30,000 jobs and the $10 billion economic injection that an expansion would offer, according to a study commissioned by the Indiana Hospital Association.

Many of those Republicans didn’t support President Barack Obama’s health care law in the first place, but now that it’s in effect, they have little interest in continuing to debate a federal issue. Foremost among them is Ed Clere, R-New Albany, who is trying to persuade fellow members to see it his way.

“Frankly, I think there’s some feeling among some legislators that this debate is about the Affordable Care Act, and it’s not. This debate is about the issue of Medicaid expansion in Indiana, and what that would mean for the state,” he said.

One compromise that seems possible involves using the Healthy Indiana Plan, which requires those who are enrolled to chip up to 5 percent of their income into a health savings account plan worth $1,100 per year, as the vehicle for a Medicaid expansion.

Pence sent U.S. Department of Health and Human Services Secretary Kathleen Sebelius a request for the federal government to give Indiana the green light to use that plan to expand Medicaid, saying only after receiving a “yes” would he make a decision.

Clere has offered a bill that would set such an option in motion. It would have Indiana expand Medicaid through a program similar to the Healthy Indiana Plan, as long as federal officials allow it. (There’s been no new analysis on how expensive expanding that program would be, compared to traditional Medicaid.)

That bill was slated for a vote in the House late last week, until Pence intervened.

The governor called Clere and three other Republican lawmakers into his office for a meeting to send the message that he doesn’t like House Bill 1591.

The Thursday morning meeting included House Ways and Means Chairman Tim Brown R-Crawfordsville, House Insurance Chairman Matt Lehman, R-Berne, and Rep. Steve Davisson, R-Salem, who is Clere’s vice chairman on the House Public Health Committee.

The governor “expressed his hesitation to undertake any expansion at this time,” Clere said.

The bill would take a final decision on whether to expand Medicaid out of Pence’s hands. It also would have allowed for tweaks to the Healthy Indiana Plan.

“Governor Pence made it clear in his letter to Secretary Sebelius that all discussions about Medicaid expansion in Indiana must start with the Healthy Indiana Plan,” said Pence communications director Christy Denault.

The House has scheduled Clere’s bill for a vote on Monday — a key day, because it’s the deadline for the chamber to send bills over to the Senate for consideration.

The top House Democrat, Rep. Scott Pelath of Michigan City, said Friday that Clere’s bill “needs to get a vote — it will pass.”

However, Clere said he might pull back so that he can rework his legislation as an amendment to a Senate bill — and use that time to try to find something Pence would support.

“There’s ample opportunity for us to continue to work on this issue of potential Medicaid expansion,” Clere said. “I’d rather do it in a constructive fashion with everyone at the table, including the governor, and try to reach consensus on a difficult issue that is probably one of the most important issues before the Legislature.”

Still, Clere said, Health and Human Services might not act on Pence’s request to use the Healthy Indiana Plan as a Medicaid expansion vehicle until well after the General Assembly’s 2013 session wraps up on April 29 so a bill addressing the issue might advance regardless of Pence’s position.

“The legislative session is finite, so we can’t sit around waiting. We’re going to come to a point in the very near future when we will have to act on this issue, regardless of what has or hasn’t come out of Washington,” Clere said.

“It’s a complex issue, there’s no question. But just because it’s complex doesn’t mean we shouldn’t do everything we can to address it fully.”