As Indiana Governor, Mike Pence’s Health Policy Has Been Contentious Wednesday, Jul 20 2016 


Indiana governor Mike Pence is in the spotlight this week as the man Donald Trump has chosen as his running mate. His decisions about health and healthcare in Indiana have drawn attention from within and outside the state. And his record could be important in November, because his running mate doesn’t have a legislative record at all.

Here’s a quick look at the governor’s record on health policy in Indiana.

Medicaid Expansion

Pence has been a vocal opponent of Obamacare, or the Affordable Care Act, even after the law passed in 2010 and was upheld by the Supreme Court.

But when faced with the choice of whether to expand Medicaid to cover Indiana residents who earn 138 percent of the federal poverty level or below, a key part of the ACA, he made a compromise. He debuted a conservative-friendly version of the expansion, one that requires Medicaid recipients to pay a monthly contribution, based on income, into a health savings account. Miss a payment, and you can be bumped to a lower level of coverage, or lose it entirely, for six months.

Now, after a year and a half, the Healthy Indiana Plan, or HIP 2.0, has enrolled about 190,000 more people into health coverage.

Caitlin Priest, director of public policy at Covering Kids & Families of Indiana, says the plan has helped many people get health insurance for the first time in their lives.

“It’s really been a wonderful way to move the needle both on healthcare access and ultimately on long-term health outcomes,” she says.

Pence took criticism from the right for accepting a component of Obamacare, but his conservative tweaks to Medicaid have other Republican-led states looking at that model,

HIV Outbreak

Pence drew criticism from local and national infectious disease experts for his response to an urgent health crisis in Indiana. In February of 2015, the state reported an outbreak of HIV in Scott County, blamed on opioid addiction and needle sharing.

It got so bad—growing to more than 80 cases within a month after the announcement and more than 190 to date—the CDC came in to investigate, and public health experts began calling for a needle exchange. At the time, syringe exchanges were illegal in the state and Pence was opposed to changing that, at first.

He later signed an emergency declaration allowing Scott County to start a needle exchange. Rather than legalize exchanges statewide, Pence signed a bill that forces counties ask permission to start a needle exchange.  

Only a few counties have done it so far because the process takes a lot of planning, local support and money, which the state doesn’t provide, says Carrie Lawrence, a researcher with the Rural Center for AIDS/STD Prevention.

“If you’re the health department with only two part-time staff and a full-time health director, who’s going to do this, and when is it going to happen?” Lawrence says.

Public Health Budgets

Lawrence says the HIV crisis also brought some attention to Indiana’s lack of public health funding in general.  “I think we are dealing with the consequences of the fact that that we don’t have a strong infrastructure for public health in the state,” she says.

As governor, Pence signed legislation that cut Indiana’s budget for public health programs, despite the state’s many pressing public health problems. The state has a high smoking rate, high obesity rate, and high infant mortality rate. Indiana is ranked nearly last for both federal and state public health funding. According to Trust for America’s Health, Indiana spends just $12.40 per person. West Virginia, the number one state, spends more than $220.

As a member of Congress from 2001 to 2013, Pence voted against funding for health programs such as the State Children’s Health Insurance Program and the Prevention and Public Health Fund.

Abortion Access

As a congressman, Pence was an early advocate for defunding Planned Parenthood, and this year, women’s health advocates have clashed with Pence again.

In March, the governor signed a bill that’s been cited as one of the most restrictive in the country, barring abortion on the basis of of disability, gender or race of the fetus. It also requires women to get an ultrasound at least 18 hours before the procedure, and that the fetal remains be buried or cremated.

Some Indiana women responded by updating the governor’s office with (sometimes graphic) news on their menstrual cycles by phone and on social media with hashtag #periodsforpence. The social media backlash mirrors #periodsarenotaninsult, which took aim at Trump last year.

The Indiana ACLU brought a lawsuit against the state—and a judge has since blocked portions of that law. “What the state of Indiana has attempted to do here…grossly flies in the face of existing law,” says ACLU lawyer Ken Falk.

Humana, Aetna shares fall sharply on new antitrust concerns Monday, Jul 11 2016 

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Shares of Aetna and Humana plummeted late Monday afternoon after a trade publication said the companies’ proposal to sell some of their assets are unlikely to satisfy antitrust regulators’ concerns about their merger’s impact on competition. Humana’s shares fell nearly $9, or about 5.4 percent, in less than 10 minutes of trading this afternoon. They also […]

Humana shares plunge 10 percent on antitrust worries Thursday, Jul 7 2016 

Photo by Stephen George

Humana’s shares plunged nearly 10 percent today after an antitrust trade publication reported that federal regulators have serious concerns about the company’s acquisition by rival Aetna, whose shares fell 4 percent. Officials from both companies are set to meet on Friday with antitrust regulators of the U.S. Department of Justice who have voiced “significant concerns” […]

Norton grants $1.25 million to UofL for pediatric research Wednesday, Jul 6 2016 

Thomas D. Kmetz, division president, Women’s and Children’s Services and Kosair Children’s Hospital, talks about the importance of the relationship between Norton Healthcare, Kosair Children’s Hospital and the University of Louisville prior to announcing a $1.25 million gift to the university for research initiatives.
In the background from left, are Dr. Steve Hester, Norton Healthcare system senior vice president and chief medical officer; Dr. Greg Postel, interim executive vice president for health affairs at UofL;  Dr. Gerard Rabalais, the Billy F. Andrews Endowed Chair of Pediatrics at UofL. | Courtesy of Norton Healthcare.

Louisville-based Norton Healthcare has granted $1.25 million to the University of Louisville to foster research that will help children with medical conditions including autism, heart disease and cancer. “Research is vital to advancing the care we, as partners, can provide to children,” Norton’s chief medical officer, Dr. Steven T. Hester, said in a press release. […]

Louisville-based Family Allergy buys sleep medicine business Tuesday, Jul 5 2016 

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Family Allergy & Asthma of Louisville has bought Expert Sleep Medicine and its four offices in and around Jefferson County. Dr. James Sublett, co-founder of the allergy company, told Insider that the acquisition made sense because of some patient overlap and because the two companies’ cultures aligned. For three years, FA&A has performed some back office […]

What Happens If Bevin Repeals Kentucky’s Medicaid Expansion? Friday, Jul 1 2016 

Gov. Matt Bevin says he’ll do away with Kentucky’s expanded Medicaid system if the federal government doesn’t approve a waiver he’s seeking to change the expansion.

So what would happen to the 440,000 Kentuckians who have taken advantage of the expansion since it was implemented in 2014?

That depends on each of those individuals’ incomes.

Marybeth Musumeci, associate director of the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured, says those who earn more than 100 percent of the federal poverty level — $11,770 for an individual — would be eligible for subsidized private insurance through the federal marketplace.

“They would likely experience higher out-of-pocket costs compared to what they experience under Medicaid, and there may be some differences in the benefit package,” she says.

Meanwhile, many below 100 percent of the federal poverty level would fall into a coverage gap experienced in states that didn’t expand Medicaid: they neither qualify for subsidies nor Medicaid benefits.

“You could purchase a plan but you would have to do so at full cost, and it’s highly unlikely someone would be able to afford that at that income level,” Musumeci says.

Former Gov. Steve Beshear enacted Kentucky’s Medicaid expansion by executive order. The program enlarged the eligibility pool for Medicaid by authorizing people with incomes up to 138 percent of the federal poverty level — $16,242 for a childless adult.

Previously, childless adults did not qualify for Medicaid unless they had a disability.

If the expansion were rescinded and eligibility reverted to levels from before the Affordable Care Act, that would mean only disabled people, unemployed parents earning below 33 percent of the federal poverty level and employed parents earning below 57 percent of the federal poverty level would qualify.

Bevin campaigned on scaling back the Medicaid expansion, saying it would grow to be unaffordable as the federal government rolls back its assistance of the program.

Until now, the federal government has subsidized 100 percent of the cost of the Medicaid expansion. That subsidy drops to 95 percent starting in the 2017 fiscal year and to 90 percent in the 2020 fiscal year.

Bevin’s administration has put together a proposal that they estimate would save the state $331 million over the next five years. But during his announcement of the program, Bevin said the proposal — officially called an 1115 waiver — isn’t just “about trying to save money.”

“The money will come by doing the right thing,” Bevin said. “Better, healthier outcomes result in cost savings on health expenditures, that’s the reality.”

Bevin’s proposal, which would require federal approval, is to start charging monthly premiums for Medicaid recipients, eliminate vision and dental coverage and create incentives for healthy behavior and volunteer work.

Officials estimate about 86,000 fewer people would be enrolled in the program by July 2021 if approved.

Bevin’s office says if the Medicaid expansion isn’t changed, the state will pay about $1.2 billion over the next five years on the program.

Jason Bailey, executive director of the liberal-leaning Kentucky Center for Economic Policy, says eliminating the expansion won’t save the state money.

“Those costs will go up — they’ll go up in people’s insurance bills, they’ll go up in what the state spends on uncompensated care, so it’s not a net savings,” Bailey says. “And in the long-term, it’s definitely not a net savings when we see our health deteriorate because fewer people are getting the treatment they need to get healthy and stay healthy.”

State officials say they plan to submit Bevin’s proposal for changes to the Medicaid system on Aug. 1 with hopes of receiving approval by September.

Musumeci with Kaiser Family Foundation says it’s unlikely the proposal would be approved that quickly — similar negotiations with the federal government have taken years.

“Typically when they’re approved, they don’t end up looking exactly like the proposals, there’s a lot of negotiations that goes on back and forth between CMS and the states,” she says.

Bevin has suggested that he would repeal the expanded Medicaid program if the waiver is not approved, though he says the onus would be on the federal government.

“If they do not approve this, there will not be expanded Medicaid in the state of Kentucky,” he says.

No other state has expanded and then repealed a Medicaid expansion since it became possible to do so under the Affordable Care Act.

Bevin’s Medicaid Proposal Criticized At Frankfort Forum Wednesday, Jun 29 2016 

A public hearing on Gov. Matt Bevin’s proposal to change the state’s Medicaid system drew mostly backlash from a packed crowd in Frankfort on Wednesday.

Bevin wants to require most Medicaid recipients to pay monthly premiums, eliminate vision and dental coverage from the program and create an incentive system that would allow people to volunteer or get job training in exchange for more benefits.

Harriette Seiler, a Louisville resident, said Bevin’s plan for Kentuckians to put “skin in the game” will “scrape a pound of flesh” from the most vulnerable people.

“The sick and the poor and the unemployed are not naughty children who need to be incentivized or scolded or humiliated by constantly having to prove how poor they are in order to sign up for care,” Seiler said.

Bevin and other state officials have been meeting with representatives from the U.S. Health and Human Services Department in anticipation of applying for an 1115 waiver, which allows states to change their Medicaid programs.

Kentucky is one of 26 states that has a fully-expanded Medicaid program, which makes people up to 138 percent of the federal poverty line eligible for Medicaid. There are six additional states that have expanded Medicaid but have received a waiver as an alternative to the traditional program.

Bevin’s proposal would require most beneficiaries to pay premiums ranging between $1 and $15 per month and lock out those who don’t pay. Recipients would be able to get benefits again once they take a health literacy class and pay back the amount they owe.

Adam Meier, Bevin’s deputy chief of staff, said the program is designed to help people transition to private insurance.

“This whole plan is really to help teach people how to be engaged in their health, in their insurance plan, to teach them how commercial coverage works and the basic elements of those programs,” Meier said.

If Bevin’s waiver goes into effect, state officials predict about 86,000 fewer people will be on Medicaid and the state will save about $331 million over the next five years.

Nancy Galvagni, senior vice president of the Kentucky Hospital Association, applauded the program, saying Kentucky’s current Medicaid system is not sustainable.

“Since most health costs are related to unhealthy lifestyle choices, we really think that in the long-term the only way to really lower the Medicaid program cost is to incentivize individuals to make different choices about their lifestyle and their use of healthcare services,” Galvagni said.

Medicaid covers about 1.3 million Kentuckians, about 30 percent of the state’s population. Since 2014 when the Medicaid expansion took effect, more than 440,000 people have enrolled in the expanded program.

Elizabeth Partin, a nurse practitioner representing the Kentucky Nurses Association, asked state officials to consider putting some form of vision and dental coverage into the waiver proposal.

“I don’t think that one annual eye exam or one annual dental exam is going to break the bank either way,” Partin said. “And it may help to improve people’s health.”

Bevin’s official plan is posted on the state’s Cabinet for Health and Family Services website. Officials said they intend to submit the waiver to the federal government on Aug. 1, with hopes of getting approval sometime in September and rolling out the program in the spring.

California official blasts proposed Humana merger, shares drop Friday, Jun 24 2016 

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Shares of Aetna and Humana plunged Thursday afternoon after the insurance commissioner of the country’s most populous state said he opposes the proposed merger of the two health insurance giants. California Insurance Commissioner Dave Jones said in a conference call shortly after 1 p.m. Thursday that a merger between the two companies would reduce competition and […]

Humana to move 1,200 more employees into downtown Louisville Tuesday, Jun 21 2016 

A screenshot of Humana's Blankenbaker facility taken off Hollenbach-Oakley's website.

Humana plans to move nearly 1,200 employees next summer from an office park in east Louisville to two buildings in the city’s downtown. The insurer said it notified the employees today that the sublease of its building in Blankenbaker Station, 12501 Lakefront Place, about 15 miles east of downtown, will expire in the summer of […]

SummerWorks program expands to 2,700 interns Monday, Jun 20 2016 

Mayor Greg Fischer kicks off the 2016 Summer Works program at Humana Monday afternoon. The program connects local employers with young interns. | Photo by Boris Ladwig.

About 2,700 young adults will gain valuable work experience with Louisville area employers in the next few months as they complete internships as part of the 2016 Mayor’s SummerWorks Program. Mayor Greg Fischer kicked off the event Monday afternoon at Humana’s Digital Experience Center, where employees work on such projects as the Humana Vitality and […]

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