Politics 101

Governor Mike Pence has unveiled a proposal to expand Medicaid using Healthy Indiana, prompting blogger Steve Benen to suggest that Indiana’s Governor might be “evolving.”

Although I’m sure Pence would reject terminology that even slightly referenced evolution, his plan to expand Medicaid through Healthy Indiana is a good thing. That it is also a brave thing is a sad commentary on the current GOP, which is where most criticism of the proposal has come from.

It seems to be slowly dawning on Pence that there is a considerable difference between pontificating in DC and actually running a state. In Washington, the man who has been described as “a Tea Partier before there was a Tea Party” could–and did– sermonize ad nauseum without paying a political price. He could–and did–ignore the nitty-gritty of actual lawmaking (he served 11+ years without passing any legislation). A chief executive doesn’t have that luxury; he’s expected to actually do something.

And a chief executive with ambitions/delusions of higher office will be evaluated on the “somethings” that he did.

The problem is, when you are a Republican Governor, you have to satisfy a base that demands ideological purity and ever-more-red meat, at the same time that you have to deal with real budgets, real challenges and the real consequences of bad decisions.

Pence–and several other GOP officeholders–think they’ve figured a way to thread that needle.

We saw it earlier with Common Core. When the GOP suddenly turned on a dime and decided that Common Core was evil (right after the scary black dude in the White House embraced it), Republicans who’d previously been very supportive of Common Core faced a dilemma. They solved the problem by passing  “Indiana” standards that looked a lot like Common Core, but were called something else.

Now we have Medicaid expansion by a different name.

Mind you, these strategies are A-OK with me. There really is no “Hoosier” version of math (unless you count the time our legislature passed a measure changing the value of pi…); and 350,000 Indiana citizens desperately need access to affordable health care. If the current Administration has to engage in a bit of misrepresentation to get it done, I won’t complain.

It’s just a shame that these gyrations are necessary in order to avoid being eaten alive by the angry, uninformed people who now control the party.


  1. My daughter-in-law began last October attempting to access the ACA web site; this of course led her to the Indiana health care site which requires applicants be accepted or denied by the state health program before they can apply to ACA. She finally completed an application in January which was lost in the health care shuffle – no idea which health care shuffle – was told she COULDN’T be informed of her status till April or May. ACA deadline was March 31st. She is still waiting for some word, acceptance or denial so she can apply somewhere – anywhere – for reasonable family health care coverage. You won’t see this in the media any more than Pence will admit publically to holding up health care coverage to Indiana residents to show that man in the White House the GOP will not be controled by federal laws.

  2. If the governor is successful at this sleight of hand, things may really sour for him. If ACA advocates, who want everything that the ACA offers, believe Pence has not expanded Medicaid, he is dead for them. If the right thinks he really has expanded Medicaid, he is dead for them. That is one of the possible outcomes of hypocrisy.

  3. JoAnn – your daughter-in-law was misinformed. The federal exchange (healthcare.gov) offered the option to apply to your state’s Medicaid (or HIP) plan in addition to applying for private coverage, but this is not mandatory. Lots of Hoosiers bought health insurance on the exchange without applying for Medicaid or HIP. Sorry she missed the enrollment window because of this misinformation.

  4. Mary; she was denied Medicaid due to income level but didn’t apply for that, it was all the other possibilities they wouldn’t accept or deny her application. Their 20 year old son, a college student, did qualify for Medicaid but didn’t apply for it as they have him on their current family plan with a $9,600 annual deduction. Both parents and 14 and 12 year olds still listed as “possible acceptable” applicants. She can get no other response.

  5. Another issue that seems to be sleight-of-hand: The press release says “It facilitates linkages to employment services and rewards individuals for securing employment and moving off public assistance”.
    I can’t find any further details on the HSSA site about what these “rewards” might be. The waiver applications says
    “HIP participants who are unemployed or working less than 20 hours a week will be referred to available employment, work search and job training programs that will assist them in securing gainful employment.”
    It’s not clear if participating in such programs would be mandatory (a requirement that seems unlikely to gain federal approval) or merely suggested. Also not stated: where are the funds and the personnel for Workforce Development to deal with possibly 300,000 new job-seekers?

  6. Mary, the devil is in the details, and the more details are revealed and the more meaningful questions are asked, (as you have done) the devil will be revealed. If this proposal does pass muster, I envision these folks being able to bury it somewhere because it is “voluntary”, dealing with it in a passive aggressive way. While sitting on it, they will say, “I’m not sure where I put it” or “It’s here somewhere; come back tomorrow”.

    I think that a lot of people view Pence as having some sort of Damascus experience, or are relieved that he seems to be complying with the law, when in fact, all of that may be an illusion. The smart money will investigate the level of deception.

    Why don’t I trust this guy?

  7. Stuart; you don’t trust this guy because you have been paying attention. By the way; my son and daughter-in-law both work and pay $450 for their health care family plan, the monthly payment is within reasonable limits in today’s market. It is the $9,600 annual deductible that is not. They pay monthly premiums and all pay medical expenses – they pay $450 monthly for NOTHING. The same plan for a single person is $425 monthly with a $4,000 annual deductible. This is the only health care option where my daughter-in-law works.

  8. The whole Health Care system is shamble. We should have One National Health Plan. This idea that each state should design it’s own plan is ridiculous. Manufacturers do not design and build a product for use in single state. I can buy a Toyota or Honda in New York and expect it to work here in Indiana.

    Max Baucus D-Montana from WIKI – Baucus called the first Senate meeting of interested parties before the committee to discuss health care reform, including representatives from pharmaceutical groups, insurance companies, and HMOs and hospital management companies. The meeting was controversial because it did not include representatives from groups calling for single-payer health care.
    May 2009 Statements by Baucus that “single payer was not an option on the table.”

    The pay-off for Slapsie Maxie – From 2003-08, Baucus received $3,973,485 from the health sector, including $852,813 from pharmaceutical companies, $851,141 from health professionals, $784,185 from the insurance industry and $465,750 from HMOs/health services, according to the Center for Responsive Politics

  9. Louie is correct …

    (The whole Health Care system is shamble. We should have One National Health Plan.)

    What was created is no more than a healthcare supermarket. With everybody wanting this bit and that bit.

    One Plan for everybody with a flat fee, deducted from our paychecks before taxes and for those who don’t have a job, coverage as part of unemployment benefits etc. And while we are at it, Scrap the VA system and bring all those vets into the the One Plan system also.

  10. Louis and Red George are correct. Until we remove ‘PROFIT’ from healthcare, we will all pay more. But the trend will be that employers will stop offering health care benefits and everyone will have to go to the exchanges to get it and THAT is when the costs will come down and sanity will ensue. I believe there was a couple of articles about that recently in the NYTimes. I’ll see if I can track it down and post the link later.

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