Mike Pence, Donald Trump's chosen running mate, may draw mixed reactions for his health policy positions.
The Indiana governor has won strong support from religious conservatives for his positions on abortion, Planned Parenthood, embryonic stem-cell research and other issues. In March, he signed a bill outlawing abortions based on fetal disabilities such as Down syndrome. A federal judge last month blocked the bill.
But his decision to push through a personal-responsibility version of Medicaid expansion in Pence's state last year angered many conservatives. While the White House praised him last week for doing “important work” to expand Medicaid, conservative journalist Philip Klein described Pence's “drastic expansion in entitlements” as a “betrayal,” and said he instantly “went from hero to zero for many conservatives.”
Still, Pence's Healthy Indiana plan—which includes premium contributions, health savings accounts, incentives for healthy behaviors, and a benefit lock-out for people who don't pay premiums—has become a model for conservative Republican governors in Arkansas and Kentucky. He currently is battling the CMS over an independent evaluation of how the Indiana waiver model has affected access to care.
Pence now will be in the position of calling for repeal of his own Medicaid expansion, which has extended coverage to nearly 350,000 low-income adults. Trump advocates fully repealing the Affordable Care Act, including the expansion, and turning Medicaid into a capped state block-grant program. Keeping the expansion after repealing the ACA's revenue-raising provisions would be difficult.
“I distrust the intent of 50 different states to appropriately support people who need health coverage through the complete freedom of block grants,” said Dr. William Conway, CEO of Henry Ford Medical Group.
But analysts doubt Pence will face serious conservative resistance based on his Medicaid expansion. “The defense is he didn't just expand a welfare program, he included requirements for work, personal responsibility, and saving,” said Joe Antos, a health policy expert at the conservative-leaning American Enterprise Institute. “That's as good an argument as it gets for a Republican.”