Pence's conservative version of Medicaid expansion took effect last year. His Healthy Indiana 2.0 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 other states such as Kentucky and Ohio.
An hour after Pence dropped out the race Friday, Eric Holcomb the state's lieutenant governor and Republican U.S. Reps. Susan Brooks and Todd Rokita made moves positioning themselves to become the GOP gubernatorial candidate. Local media pegs Holcomb as facing Democratic nominee John Gregg in November. Gregg, a former state representative, won his party's state primary earlier this year.
Holcomb hasn't commented on HIP 2.0, but as Pence's second in command, he likely supports the program, according to David Craig, an ethics professor at Indiana University–Purdue University Indianapolis.
Both Brooks and Rokita issued statements of support after Pence received approval from HHS for HIP 2.0. Brooks has sided with Pence in a fight against the CMS. The agency wants to conduct an independent evaluation of how the Indiana waiver model has affected beneficiaries' access to care.
She and Pence argue the state has already hired a vendor to perform an evaluation and expressed concern that the CMS would be biased in its assessment.
If Gregg wins, he might follow fellow Democrat Pennsylvania Gov Tom Wolf's footsteps by junking his predecessor's conservative Medicaid expansion and replacing it with a straightforward approach, said David Orentlicher, a health law professor at Indiana University.
Regardless of who wins the election, providers believe that HIP 2.0 will remain intact given the program's success and its strong, bipartisan support, said Indiana Hospital Association President Douglas Leonard. As many as 350,000 people are believed to have gained access through HIP 2.0.
Others agreed. “It's been implemented very well and is firmly in place,” said Philip Morphew, CEO of the Indiana Primary Health Care Association, which represents the state's community health centers.
"Any major changes to the program would also need to be legislated,” said Lisa Mangifico, a policy analyst at the Indiana Primary Health Care Association.
The only scenario that might change that is if Republicans win the White House, maintain control over the House and Senate and follow through with threats to repeal the Affordable Care Act.