The University of Indianapolis hosted a panel discussion on Monday, April 13, at 7 p.m. in the Schwitzer Student Center addressing justice, the Affordable Care Act and the Healthy Indiana Plan, commonly known as HIP 2.0. Associate Professor of Philosophy and Religion Peter Murphy introduced the three panelists to the audience and led the discussion.
The first panelist was David Orentlicher, a professor at Indiana University School of Law and an adjunct professor in medicine at the IU School of Medicine. He also served as a member of the Indiana House of Representatives from 2002 to 2008, where he authored several important pieces of legislation.
The second panelist was Secretary of the Indiana Family and Social Services Administration John Wernert. FSSA is responsible for providing social benefits and healthcare for 1.4 million Hoosiers.
The last panelist was Executive Director of the Gennesaret Free Clinic Rebecca Seifert. Gennesaret Free Clinic is an Indianapolis organization that provides free comprehensive healthcare services for homeless people, including medical, dental, vision care and more.
Murphy began the discussion by offering some background information on HIP 2.0. He reminded the audience that in 2012 the Supreme Court ruled on the constitutionality of various aspects of President Barack Obama’s Patient Protection and Affordable Care Act.
One ruling established was that the federal government could not force states to make the choice either to expand Medicaid as dictated in the Affordable Care Act or lose all their federal funding for their Medicaid systems. Murphy explained the options available for states as a result of the ruling.
One option, taken by 22 states so far, is not to expand Medicaid. These states still have traditional Medicaid, a system for which anyone both below the federal poverty line and a child, blind, physically disabled, elderly, mentally ill, pregnant or a parent of young children is eligible. The Affordable Care Act then provides subsidies for anyone not covered by Medicaid whose income is below 400 percent of the federal poverty line.
A second option, taken by 23 states so far, is to expand Medicaid using the guidelines of the Affordable Care Act. For this, anyone under the age of 65 and under 138 percent of the federal poverty line is eligible for Medicaid. Anyone over the 138 percent can get subsidies.
Finally, the third option is one that only five states, including Indiana, have taken. This option involves applying for a waiver that proposes to the federal government that the state’s Medicaid system will be set up in a way that is different from the Affordable Care Act. Indiana’s waiver, which proposed the HIP 2.0 system, was successfully granted and continues through January 31, 2018.
The panel discussion focused mainly on the differences between Indiana’s HIP 2.0 system and the Medicaid system laid out in the Affordable Care Act.
The panel also raised ethical issues and addressed certain incentives that are distinctive of HIP 2.0 but not part of traditional Medicaid. Examples discussed included the requirement that some HIP 2.0 recipients fund a high-deductible health account and how HIP 2.0 locks those recipients out of the plan if they fail to make these payments. It also imposes a penalty of up to $25 if a HIP 2.0 recipient uses the emergency room for non-emergencies. Each panelist evaluated the efficiency of HIP 2.0.
“Why should we think that HIP 2.0 is the ideal way to go?” Murphy said. “This is basically a matter of trying to get the best healthcare we can get for every dollar that we spend.”
He added that this might strike people as an economic consideration at first, but it also might be an ethical consideration if there is an ethical requirement that public dollars be spent efficiently.
He also asked the panelists to share their views on the ethical considerations, such as the claim that HIP 2.0 will help people take personal responsibility for their health. People opposing HIP 2.0 claim that even if its efficiency is proven, the system is unfair to people who are worse off because of the burdens that it imposes on them.
Each panelist took turns answering these questions by sharing his or her own knowledge and perspectives on the subject. Seifert said that a lot of issues stem from how best to use healthcare.
“A number of our patients live in very challenging life circumstances, and so as a result, there is an issue of access to care,” she said. “But once in care, we try to make sure that our providers communicate with our patient population in a way that will allow them to efficiently use services, understand medication and the importance of coming back for health assistance, which will allow us to employ healthcare to better serve our patient population.”
Wernert addressed the issue of coverage versus access and emphasized that traditional Medicaid did not correspond to the healthcare needs in Indiana.
“What happens if there are no doctors or providers in those states that are willing to see patients on Medicaid?” he said. “Only 60,000 people were able to get on the original HIP 1.0 plan. So how did that help with the access issue?”
He said that what Hoosiers need is not just coverage but access to care.
“Patients on Medicaid really don’t get healthier,” he said. “There is no incentive for them to take more ownership and responsibility in their healthcare.”
Orentlicher gave his views about why Indiana needs such a system. He said that the United States has the highest healthcare costs in the world.
“We spend 17 percent of our gross domestic product, and we don’t spend it efficiently,” he said. “So we are not getting healthier as a result. In fact, we are less [healthy], even though we spend so much more.”
Orentlicher proposed two ways to deal with this: address physicians’ over-prescribing and discourage patients from over-demanding healthcare.
He explained how low-income people with high-severity chronic illnesses are less likely to seek medical treatment to avoid paying extra costs, emphasizing that those people are worse off by having to pay more for healthcare. After the discussion, the floor was opened to the audience for questions. Senior marketing major Aminata Diallo said the panel helped her understand HIP 2.0.
“I think that the panelists pretty much covered most of the things that I wasn’t so sure about on HIP 2.0,” she said. “And they did a great job providing [the] reasoning behind it.”