This letter is in response to the recent article “Success of Pence's Medicaid expansion far from settled,” on the Healthy Indiana Plan. We find the reporting to be incomplete in several key areas and wish to provide some additional information that was unfortunately left out of the article.
Nearly 7 out of 10 members chose to contribute to their health savings accounts, called Power Accounts, and these members were more satisfied with the program compared with those who didn't (84% to 71%); had better drug adherence (84% to 67%); sought more primary care (31% to 16%) and preventive care (64% to 45%); and relied less on the emergency room for treatment (775 to 1,034 visits per 1,000 member years). This was left out of the article. This is a critical point that speaks to the essential components of the program.
The story notes that some enrollees worry about being able to make those contributions, but more than half never (38%) or rarely (14%) worried about making contributions, which was not reported. In fact, what the article fails to mention is that a large majority of enrollees (87%) reported they would pay more to remain enrolled in HIP 2.0 and that affordability was not an issue for people who left the program. Only 5% of people surveyed who had left the program said they did so for affordability reasons.
In HIP 2.0, members who do not make contributions face penalties. Those who have a family income above the federal poverty line are disenrolled for nonpayment. Those below the poverty level are moved to a reduced-benefit program. Only 5.9% of these members were disenrolled for not making a payment and only 21,445, or 8%, were moved for failure to pay. The article reports the total number that faced the penalties (2,677) without providing the overall percentage (5.9%), which skews the interpretation of the data. In addition, while the article provided the raw total number of these members, it didn't note that 56% of these former members had actually found other coverage, either through their work or their spouse's work, which may explain why they stopped paying.
The story also resurrected the storyline that the CMS continues to want to scrutinize HIP 2.0 by conducting its own evaluation. While we certainly question the use of taxpayer dollars to duplicate research, the main issue Indiana continues to have with the CMS' research is its choice of an evaluator that we find to be biased based on prior comments made by employees of their subcontractor, the Urban Institute. This concern was left out of the article.
Finally, we want to highlight that the Healthy Indiana Plan is not an element of the Affordable Care Act. While it has been partially funded by the federal Medicaid program since 2008, it is not a component of Obamacare. The Healthy Indiana Plan existed before the ACA was passed.
Based on the clear successes of HIP 2.0, we feel it is the very sort of coverage program that states should consider when looking for an alternative to Washington's one-size-fits-all approach.