Gov. Mitch Daniels is doing the right thing by leaving the choice of whether to expand the state's Medicaid rolls to the person who succeeds him in January. The decision will have profound effects financial and otherwise for years to come, and it would be unfair to saddle either Republican Mike Pence or Democrat John Gregg with a fait accompli. For one thing, the next governor needs to hear from all of us out here in Hoosierland, and we haven't had a chance to study the implications yet.
That we even have a decision to make is a minor miracle. When the U.S. Supreme Court upheld the individual mandate as a part of the federal health care overhaul, it also went against the modern trend of ever-expanding federal power by saying that Washington cannot require that states cover more low- and middle-income workers through Medicaid.
If the good news is that we can make a decision, the bad news is that we must. There are tricky considerations and good arguments on both sides, but the answer that seems to be correct right now is not to expand the Medicaid rolls, for many good reasons, including but not limited to:
– The expense, which would be great but unestimatable. The Urban Institute says about 86,000 Hoosiers would be eligible under the expansion, which would cover anyone making up to 138 percent of the federal policy level. The federal government would pay for the total cost the first few years, but the state would then assume more and more of responsibility – billions and billions.
– The usurpation of state power. Determining how many people should be eligible for how much and what kind of health care help is one of those “laboratories of democracy” issues for which states should be able to experiment. Indiana officials have already demonstrated one way to handle health care better and cheaper than Washington's one-size-fits-all idea – the innovative, market-based Healthy Indiana Program.
– The sheer lunacy of making the soon-to-crash Medicaid program crash even sooner by making it even bigger. Of course, expanding the government's health care reach with Obamacare isn't the brightest idea in the world, either, since health care expenses have risen so dramatically mostly because so much of them are not paid for by the consumers but by third parties.
Neither Pence nor Gregg has said definitively said what he would do. At least Pence sounds highly skeptical of expansion. Gregg says only that he wants to convene meetings of all types of Hoosiers before making a decision.
Know what? That's something Hoosier voters need to know before the election. Let's hear it, gentlemen.