Covering Kids & Families — Insuring progress: Coverage insecurity threatens health gains

Editorial, The Journal Gazette, September 13, 2019

The number of those without health insurance is climbing again, after dropping for almost a decade. Census figures released this week show about 27.5 million people, or 8.5% of the U.S. population, were without coverage in 2018, up half a percentage point from a smaller increase a year earlier. It was a jump of 1.9 million people. In Indiana, the number of uninsured rose slightly, from 8.2% in 2017 to 8.3% last year, an increase of about 9,000.  

During the years following implementation of the Affordable Care Act in 2013, the number of uninsured nationally plummeted, and the number dropped dramatically after HIP 2.0 Medicaid expansion began in Indiana in 2015.  

Progress in making health care available to struggling families has ground to a halt for a couple of reasons. Several moves by Congress and the Trump administration have discouraged Obamacare enrollment. Lower unemployment rates have moved the needle, as well. But that could be a mixed blessing, as Mark Fairchild, director of policy with Covering Kids and Families of Indiana, told WBOI-FM recently.

“It could be they’re hitting that so-called ‘cliff effect,’ where now they are doing better but it’s just enough that they lose their eligibility for some benefits” including health care, Fairchild told the radio station. If so, some Hoosiers may have faced a cruel choice – between keeping subsidized health care and taking slightly better-paying jobs that don’t offer coverage. More information about the state’s situation is due near the end of this month, when the Census Bureau’s annual American Community Survey is released.  

Another change is under way, though. Indiana is one of nine states that has been allowed to impose work requirements on some Medicaid recipients. Helping able people enter the workforce should always be a goal of government benefit programs. But the devil may be in the details for benefit recipients who have limited education and no or limited digital access. If work-requirement plans are too complex and time-consuming, deserving applicants and their families could give up or be inadvertently disqualified.

Though 1.4 million Hoosiers are covered by some form of Medicaid, only about 70,000 recipients in the HIP 2.0 program fall under the new work requirements, the Washington Post reported recently.

But the Post found Indiana may have learned some lessons from the heavy-handed ways other states structured their Medicaid work requirement programs.  

Thus far, the Post reported, there has been “no massive drop-off in coverage as there has been in Arkansas, where ultimately more than 18,000 enrollees – about one-fourth of those subject to work requirements there – were booted before a federal judge ruled against the state.” 

Indiana has listed more than a dozenexemptions to the requirement, including for pregnant women, caregivers, college students and volunteers. The program has been rolled out gradually, and there is no “lockout” period that would prevent those who lose Medicaid eligibility from reapplying once their job requirements are met, the Post reported.

Indiana Family and Social Services Administration Secretary Dr. Jennifer Walthall told the Post the state’s goal is to see that no one loses health care coverage as a result of the new program. “We have to build a program that actually delivers those services, not makes it harder to get them,” Walthall said.

Considering that some Hoosiers still desperately need coverage and others may already have lost it, that may be a tough act to pull off. But with officeholders elsewhere still working to undermine the ACA and Medicaid expansion, Walthall deserves credit for trying to keep the focus where it belongs – on delivering health care.

The progress Indiana made under HIP 2.0 has not yet overcome the state’s outsize problems with substance abuse, diabetes, cancer, child abuse, mental illness and suicide. But the battles against those scourges would be far more difficult if the number of uninsured starts going in the other direction.

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“We haven’t been having dozens of calls each day where consumers have said they’re confused, or they don’t know what to do, or should they participate?” Fairchild says. “In a lot of ways, we’re hoping that’s a good thing, but in some ways that can be concerning too.”