Democrats helped a handful of Republicans in the House Public Health Committee on Monday pass legislation that could lead Indiana to expand Medicaid to an additional 400,000 Hoosiers.
Senate Bill 551 requires Republican Gov. Mike Pence's administration to negotiate with federal officials in an effort to find a compromise between the way Congress has told state to expand the program and the health savings account-based system that Indiana officials say they prefer.
It also mandates that any expansion covers several services - including mental health and optometry - that aren't part of the Healthy Indiana Plan, the state's current insurance program for low-income Hoosiers. Pence wants to use the HIP plan as the model for any Medicaid expansion.
The bill's sponsor - Public Health Committee Chairman Ed Clere, R-New Albany - said the legislation gives the Pence administration the opportunity to negotiate a plan in the "most fiscally responsible and fiscally conservative fashion possible."
"It offers maximum flexibility for the administration," Clere said. "It ensures that if some of our most important principles can't be part of a negotiated plan, then there will be no plan."
Still, a number of Republicans voted against the legislation, saying they still have questions about whether an expansion is a good idea and concerns about whether the bill is too prescriptive. As passed by the Senate, the bill would have only authorized the Pence administration to negotiate an expansion, not required it.
Rep. Suzanne Crouch, R-Evansville, said she's also doubtful that Congress will follow through with the provisions of the federal Affordable Care Act that require the federal government to pay 100 percent of the cost of the expansion for three years and 90 percent thereafter.
"The federal government is in trillions of dollars of debt and I find it hard to believe that carrot will be there as promised," she said.
And the bill's author - Sen. Pat Miller, R-Indianapolis - said she can't support the language of the bill as passed by the House committee. She said it would "limit some of our negotiating ability."
But Miller said the General Assembly needs to pass something to give the administration direction as it pursues a compromise with federal officials.
Originally, the Affordable Care Act required states to expand coverage to more adults. But the U.S. Supreme Court ruled last year that Congress couldn't force states to participate.
Still, many states - even some with GOP governors that opposed the federal health care law - are moving forward with expansions.
Pence has said he would consider providing coverage to more Hoosiers if the state could do so through the Healthy Indiana Plan but he hasn't committed to doing so.
If passed by the full House, SB 551 will almost certainly go to a conference committee, where key members of both chambers will try to work out a compromise between their differing versions of the legislation.
Rep. Charlie Brown, D-Gary, said lawmakers still have plenty of time to "iron out the differences" before the session ends at the end of this month. "We need to look at the bigger picture of how we get health coverage for the largest number of Hoosiers possible," he said.
Brown was one of several Democrats who voted for the bill, giving it the support needed to pass.
"I really don't want Indiana to be an island of the uninsured," said Rep. Greg Porter, D-Indianapolis.
The bill is now expected to move to the House Ways and Means Committee, which will consider the bill's impact on the state budget.
Lesley Weidenbener is managing editor of TheStatehouseFile.com, a news service powered by Franklin College journalism students and faculty.