Dollars and Sense

This morning, I was scheduled to participate in a statehouse rally intended to urge the Governor and General Assembly to exhibit rational behavior, also known as Medicaid expansion under the Affordable Care Act. (Of course, this is Indiana, where rational political behavior can be pretty rare.)

The weather required organizers to reschedule, but I’m posting my prepared remarks, which centered on dollars and sense.


Many of us have just wished our friends and loved ones a healthy, happy and prosperous New Year. In Indiana, those are going to be elusive goals.

According to a report issued in December by the respected Kaiser Family Foundation, Indiana stands to forego17.3 billion dollars between 2013 and 2022 because we are refusing to follow the lead of surrounding states (including those governed by Republicans) and implementing the ACA’s Medicaid expansion.

Indiana is refusing to accept the federal dollars that would pay for expansion of Medicaid despite the fact that over half a million Hoosiers have lost employer-sponsored coverage since 2000, and despite the fact that Indiana has seen the nation’s largest loss of health insurance coverage for children. More than eighteen percent of Indiana children have lost coverage since 2000.

Let’s talk dollars and sense.

Under the ACA, the federal government will pay 100% of the costs of expanded Medicaid for the first three years and 90% thereafter. Expansion would actually save Hoosier taxpayers money, since some of those federal dollars would pay for services we currently provide.

Since there is no rational reason to forego billions of dollars and deny a quarter of a million Hoosiers access to affordable coverage, some Indiana officeholders have resorted to deliberately misleading their constituents. One legislator recently sent out a survey seeking “input on legislative topics”.  The Medicaid question read as follows:

 “Currently, one out of six Indiana residents is on Medicaid, or about 1.1 million Hoosiers. Medicaid makes up about 14 percent of the state’s budget. Under the Affordable Care Act (or Obamacare), Indiana can expand Medicaid to cover more uninsured Hoosiers at a projected cost to taxpayers of more than $1.4 billion by 2020. This expansion would allow one in four Indiana residents to enroll in the program. Do you support full Medicaid expansion for Indiana under Obamacare guidelines?”

The question clearly–and dishonestly–implies that Indiana taxpayers would foot the bill for expansion. (Of course, he might get an answer he doesn’t want if he explained that new federal dollars would cover the costs.)

The question we need to ask our Senators and Representatives is pretty simple: Why are you refusing to allow the federal government to pay the entire cost of expanded coverage for three years and 90% thereafter—especially when those dollars you are rejecting would create an estimated 30,000 Hoosier jobs and, according to health economists, would reduce premiums paid by those of us who do have private insurance?

The only response I’ve heard is weak and highly speculative: the federal government might stop paying the full 90% at some future time. But if the feds cut payments, we could cut services, so that excuse just doesn’t pass the smell test.

It’s hard to escape the conclusion that Indiana is leaving 17 billion dollars on the table, leaving more of our citizens uninsured, costing Hoosiers who are insured more money, and refusing to cover Indiana’s most vulnerable children simply because our governor and state legislative leaders will oppose anything and everything proposed by this President, no matter how that opposition affects the citizens they were elected to serve.

Here’s a news flash: you don’t have to like this President—and you don’t have to like the Affordable Care Act—in order to accept billions of federal dollars that will save lives and money and create jobs for the people of Indiana.

Thanks to Governor Pence’s refusal to implement  Medicaid expansion, Hoosiers will pay higher state taxes, higher health insurance premiums and higher out-of-pocket expenses. And those costs will fall most heavily on those who can least afford them.

Our politicians may be aiming at President Obama, but the people they are hurting are the Hoosiers who elected them.



  1. Sheila; I certainly hope you get to put this statement to the Governor and General Assembly. Even more; I hope it will be heard, UNDERSTOOD, and heeded. Refusal of these vital aids is in opposition of Pence’s begging for disaster relief in Kokomo (which was denied) and now seeking federal disaster relief for this current terrible winter storm and it’s aftermath. Much of the current problems throughout the storm area are due to the lack of prevention and clearing of the previous winter storm. Do they not realize that the same people they are denying offered public assistance to are many of the same Indiana residents who need disaster relief in addition to their already dire circumstances? The elderly, disabled and needy are virtually imprisoned in their homes; many without heat and food. My grandson is a freshman at BSU; there is NO FOOD in his dorm – and how many other college students are in this situation? They have to go out into this deadly cold to find food if they can. It is not only the low-income population who need assistance on all levels at this time and those who have been denied help due to Pence’s refusal to accept OUR tax dollars in the form of expanding public assistance is adding injury to insult. NO, I did not unknowingly phrase that term incorrectly. That is the only term – and fact – that fits this deplorable situation.

  2. Perhaps what Pence and the opposition to Medicaid expansion do not want to admit is that our economy in Indiana is so weak our job market so bereft of Living Wage Jobs that one in four Indiana Residents would qualify for Medicaid. Perhaps also they may see the expansion of Medicaid as a step toward single payer system.

    What I see in Pence is a profound indifference to people who cannot afford Health Care.

  3. The operative words are: “the people who elected them.” Remember someone once said, “They know not what they do.” We do not have an informed electorate and will not reform until we do. As long as we vote race over reason, we are in their pockets

  4. Earl, right on! When you hear about the polls that say x% do/don’t support the President and remember that these are the same folks who believe in a flat earth, who don’t know that WW II was fought in the 20th century, etc., it’s expecting an awful lot to hope people will become an informed electorate. For people who believe that the “age of miracles” has passed, just consider the fact that this country still exists after 225+ years of voters who are proud of their ignorance.

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