By Fran Quigley
Plenty of healthcare experts have come to the Indiana Statehouse to express their opinions on Governor Mike Pence's decision not to expand Medicaid coverage as allowed by the federal Affordable Care Act. But only one group has done so by braving sub-zero wind chill temperatures, marching down the sidewalk through the snow, and chanting, "Up with justice, down with hate/Hoosiers need a healthy state!"
Members of the Service Employees International Union Healthcare rallied on Tuesday on the east steps of the Statehouse before going inside to meet with legislators. "We are asking Governor Pence to extend Medicaid so that it can cover workers like us," said Theresa Johnson, a home healthcare worker from South Bend.
Johnson struggles with an autoimmune disorder, a pinched nerve in her back, and arthritis, all making it difficult for her to care for her patients. But she is without healthcare coverage due to Pence's choice not to take advantage of federal subsidies under the Affordable Care Act. The federal law now provides funding for states to expand Medicaid coverage to all residents with incomes at or below 138 percent of the federal poverty level. If Johnson was a resident of states surrounding Indiana, she would qualify for Medicaid under the new law.
Instead, Pence has proposed using the state's Healthy Indiana Plan, known as HIP, as a substitute for Medicaid expansion. But HIP is far from a match for Medicaid, advocates for the poor say. HIP has a cap on its enrollment, unlike Medicaid, leaving as many as 181,000 eligible low-income Hoosiers like Johnson still without coverage. Plus, HIP is not available to workers whose employers provide health insurance, no matter how unaffordable that health insurance plan may be.
The very feature that the governor cites as the highlight of HIP, a requirement that enrollees contribute to a $1,100 deductible-like fund that Pence says puts "skin in the game," is a proven barrier to sustained coverage. Research has confirmed what service providers say they see every day: requiring the cash-strapped poor to make payments for health coverage will not work for many families. Emergencies such as family crises, housing loss, or criminal victimization, when paired with the no-room-for-error financial situations many Hoosiers face, will cause many low-income families to be unable to make payments, and they will be kicked off coverage as a result. eastate
Hoosiers whose incomes are at or above 100 percent of the federal poverty level—$19,530 annually for a family of three—can buy insurance on the federal health exchange, and many will receive subsidies to help with the cost. But, in a cruel irony, those making less than that amount are likely to not qualify for any help at all. Indiana's current Medicaid program covers only families with income below 24 percent of the federal poverty level and does not cover most single adults.
For Theresa Johnson, she lives with pain and makes do with over-the-counter medications. She hopes for a day when she can receive some of the professional healthcare she provides her patients. "Maybe one day Governor Pence or someone in his family will need the kind of healthcare we provide, and he will want someone healthy to give them the care they deserve," she said.