Monday, May 5, 2008

A Plan for Hoosiers 

By Grace-Marie Turner

Categories:  Indiana

Mitchell Roob and Seema Verma describe the success of the Healthy Indiana Plan (HIP) in a blog posting for Health Affairs.

HIP is the first Medicaid expansion in the nation to be modeled in the spirit of a high deductible health plan/health savings account, which promotes personal responsibility while providing subsidized health protection to those who can least afford it. The plan is a melting pot of philosophical approaches and compromises; a plan that has attracted liberals and conservatives; and a plan that has withstood the test of CMS scrutiny and Medicaid rules, write the authors. HIP brings recipients and the State together in a market-based partnership to use resources judiciously and to promote provider competition resulting in improved transparency, quality and value for all Hoosiers, they write.

Roob is secretary of the Indiana Family and Social Services Administrationand Verma is a consultant.

• posted by Grace-Marie Turner
• 8:19 am
• 0 comment

Wednesday, March 26, 2008

Vigorous Uptake for Healthy Indiana 

By Grace-Marie Turner

Categories:  Indiana

The Healthy Indiana Plan shows how consumer-driven coverage can help in the public sector, reports the Milwaukee Journal Sentinel.

Shelley Ross was the first of about 28,000 lower-income people who have signed up so far for the Healthy Indiana Plan, meant to subsidize coverage for adults who have no insurance. She signed up in December, had a cataract excised soon after, had the mammogram she was putting off. Demand to enroll in the program has been three times what officials expected, says Mitch Roob, the state's secretary of social services. Medicaid covers catastrophic care when bills exceed $1,100 a year. For routine care under that, the patient pays out of an account funded jointly by the state and the policy holder. Anything left over in the account rolls over to next year. The price is right for Ross, who makes about $25,000 a year. At $91 a month, "I'm smiling when I write that check," she says. "It's not like I wanted a free ride."

• posted by Grace-Marie Turner
• 5:26 am
• 0 comment

Tuesday, December 18, 2007

It's HIP to have POWER in Indiana 

Consumer-directed health care for low-income Hoosiers sets the standard for the nation

By John R. Graham

Categories:  Indiana

Low-income Hoosiers just started signing up for the state's innovative Healthy Indiana Program (HIP). No this program is not a cure-all. It carries a lot of the usual baggage of contemporary state reforms, i.e., the notion that when the federal government transfers money to the state government to expand government programs the people somehow benefit, as well as a politically popular but unhealthy tobacco tax. But both these fallacies are part of pretty much every state health reform these days, and I've criticised them here and there.

To the good, it ignores the fashionable fallacy of "universal" health care through mandatory coverage that is driving the Massachusetts reform into the tank. And the best part of HIP is the POWER (Personal Wellness & Responsibility) account.

Adult Hoosiers earning between 22 percent and 200 percent of the Federal Poverty Level (FPL) will open a POWER account of $1100 annually, with the individual pitching in up to 5 percent of his income and taxpayers the rest. The state covers up to $500 preventive services before the individual starts using his POWER account. Patients, not bureaucrats will decide how to spend their health dollars.

That's POWER to the people!

Indiana ranks 30th out of 50 in the government health care category in the Index of Health Ownership: this waiver will likely increase its rank in the 2008 score. In the private health insurance category it ranks 11th, so the state recognizes that a deregulated health insurance market is important to quality care, and should be congratulated for bringing similarly good incentives into HIP. However,Indiana ranks 28th in provider burden of regulation and 34th in medical tort. These bottom-half rankings drive up costs in a way that POWER accounts cannot overcome. In order to allow its low-income citizens to benefit fully from their POWER accounts, Indiana must also make its provider markets competitive, and limit medical tort abuse.

• posted by John R. Graham
• 8:39 pm
• 0 comment

Tuesday, October 23, 2007

Daniels Begins Rollout of "Healthy Indiana" 

By Christie Raniszewski Herrera

Categories:  HSAs, etc., Indiana

Indiana Governor Mitch Daniels recently unveiled a fancy, new website to administer his “Healthy Indiana Plan,” (HIP) which was approved by federal officials late last month.

Like many state health reform plans, HIP has some good, bad, and ugly components. Among the bad and ugly provisions: Medicaid expansion for pregnant women and children up to 200% of the federal poverty level (FPL); SCHIP expansion up to 300% FPL; a “slacker mandate” allowing “children” up to the age of 24 to remain on their parents’ health insurance policies; and a 44.5-cent, per-pack tobacco tax to fund expansion of government-subsidized care for all individuals up to 200% FPL.

We’ll have to wait and see whether or not the “good”-sounding provisions turn out to be good at all. For the uninsured up to 200% FPL, HIP will establish an HSA-like ”Power Account” that will be seeded with $500 in state funds and a mandatory contribution from the “Power Account” owner. The money can be used to buy a standard benefits package from a pool of competing insurers. If the funds are exhausted, the individual can qualify for up to $1 million in insurance benefits; leftover money can be rolled over from year-to-year, or withdrawn for any purpose.

Some conservatives love the idea of “Power Accounts” – I’d suspect because, finally, a Republican governor dared to introduce an HSA-like mechanism for covering the uninsured. I’m not that optimistic. Besides the obvious crowd-out issues . . . Isn’t the tobacco tax a regressive and unstable funding source? Doesn’t “standardized benefits” mean a costly, one-size-fits-all package for everyone? And finally, are government-funded and government-administered “Power Accounts” really like HSAs, or will they become entitlements in which the government contributes more and more and individuals contribute less and less?

My fingers are crossed that we’ll see some positive answers to these questions as HIP begins implementation. In the meantime, however, free-market types should remain skeptical of seemingly-expansionist health reform plans wrapped in free-market rhetoric.

• posted by Christie Raniszewski Herrera
• 2:15 pm
• 0 comment

Monday, October 8, 2007

Indiana Inmates to Pay their Own Way 

If copays are fine for the law-abiding ...

By John LaPlante

Categories:  Indiana

Inmates at the Floyd County (Indiana) jail will now have to have copays on their medications and treatments, the county commissioners have ruled.

I'm surprised that they didn't do this sooner. It seems like something that would have a great deal of popular support.  

The Indianpolis Star finds a lawyer who says "inmates should be able to keep money in their accounts for 'necessities' without having to worry about deductions for medical care." 

• posted by John LaPlante
• 7:45 am
• 0 comment

Monday, July 23, 2007

Washington Budget Rules Harm State Reform Efforts 

A tale from Indiana

By Grace-Marie Turner

Categories:  Indiana

We sponsored a luncheon on last Monday featuring Indiana Gov. Mitch Daniels, who described to senior journalists and health policy experts his novel plan to increase access to health insurance for the uninsured through a program modeled on Health Savings Accounts.

His plan is designed to help up to 132,000 uninsured Hoosiers earning less than about $20,000 a year with health insurance, preventive care, and a funded health spending account.

The plan starts with a POWER account. The uninsured person would make a contribution, on a sliding income scale, to his or her account, with the contribution ranging from about $200 a year for those making $10,000 to about $900 a year for those earning $20,000. The state would top-off the account to bring it up to $1,100.

People would spend this money first on health care, then private health insurance, paid by the state, triggers in. There are added incentives for people to use preventive care, which, like HSAs, doesn't come out of the account.

And like HSAs, people would be able to rollover any money left in their account at the end of the year. This is indeed a consumer-friendly public program.

Gov. Daniels has taken the heat to raise the state's cigarette tax by 44 cents to pay for the plan. And now he is having to fight the Washington bureaucracy to get approval to implement it.

The reasons get into the arcane nature of Washington budgeting over the Medicaid money he needs to partially fund the program. Gov. Daniels expressed his frustrations about trying to do the right thing: Balance his state's budget (which he has done two years in a row), keep Medicaid spending in check, and pass ground-breaking legislation with bi-partisan support to provide a consumer-friendly option for the uninsured.

And now he is being penalized by the Office of Management and Budget -- the very agency he ran before being elected governor of Indiana in 2004 -- for keeping his Medicaid spending down.

States have incentives to spend as much as possible on Medicaid to draw down the maximum number of federal dollars. But here we have a responsible governor who didn't do that and who comes up with a creative plan that is fiscally responsible, yet the OMB could block him from trying something new. OMB says that Indiana's spending rate was too low in the past to approve the new program.

Gov. Daniels could be a leader in showing the other states a new way to cover the uninsured rather than using onerous individual mandates, massive new regulatory bureaucracies, and big tax hikes. But he won't have the chance if Washington puts on the brakes.

And we wonder why nothing ever changes here.

• posted by Grace-Marie Turner
• 8:13 am
• 1 comment