It seems like it was just yesterday that “private option” advocates were calling the program a “model” for reform, and that other states would soon emulate our “flexible-conservative-innovative” plan. (I apologize if I left out any cliches.) For instance, there have been media reports since 2013 describing Utah’s eagerness to expand Medicaid using a private option-like system. That still hasn’t happened yet — despite various pro-”private option” legislators and Gov. Mike Beebe repeatedly waxing poetic about the greatness of the program to the citizens of Utah. Now comes Gov. Mike Pence of Indiana with his plan to make Medicaid expansion “more conservative.” The Washington Post says “Pence’s way could become a model not only for GOP governors, but also for Democratic governors such as Terry McAuliffe (Va.) who can’t expand Medicaid without getting a Republican legislature on board.” Sounds familiar, right? Like the “private option” in Arkansas, Pence’s plan is basically just run-of-the-mill Medicaid expansion with a few cosmetic changes. That way, Pence can claim that the program is “market-oriented” and “not a long-term entitlement program.” From John Daniel Davidson at The Federalist:
The basic plan essentially requires nothing of enrollees. They get a health savings account and can either pay into it or not—the state will still cover the entire cost of the deductible and copayments will be limited to 5 percent of income, as they are for all Medicaid programs everywhere. The HIP Plus plan includes vision and dental coverage, comprehensive prescription drug coverage, and requires no cost-sharing as long as enrollees keep up with monthly contributions to their account, which range from $3 to $25 a month. If an enrollee stops paying into the account, they won’t be kicked out of the program but simply get put on the basic plan.
Conservative governors and legislators in states that have yet to expand Medicaid should reject Pence’s plan. If the last two years of “private option” politics in Arkansas has taught us anything, it’s that it becomes increasingly difficult to end or even reform a Medicaid expansion program. Once it’s begun, dependence has its own dynamic.
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