Indiana’s six months into the new health laws

A Sept. 14-15 Rasmussen Reports in Indiana revealed that 63 percent favored repealing the health reforms. Nationally in a Rasmussen Poll released on Monday, 53 percent of U.S. voters now say they at least “somewhat favor” repeal of the new national health care law, matching the lowest level of opposition since the bill was passed by Congress last March.

Proponents say that 519,000 Hoosiers will now have access to health care, instead of relying on expensive hospital emergency room treatment. But the State of Indiana sees a “worst case scenario” hit to taxpayers up to $3.6 billion in the next decade, according to a study by Milliman Inc. In addition, a number of Indiana hospitals in small towns and rural areas face an uncertain fate.

Yet, according to research by Brittany Brownrigg of Franklin College who interned with Howey Politics Indiana this summer, Hoosier  hospitals spent over $517 million in charity care in 2009, according to the Indiana Hospital Association. This amount is up 17 percent from 2008. Indianapolis’ Wishard Hospital alone spent $223 million last year on caring for people without a third-party payer source.

Without the health reforms, the amount of charity giving by Indiana hospitals is projected to cost the federal government and consumers $5.5 billion over the coming decade, and close to $3 billion at Wishard alone.

The shrillest, most uninformed critics of the ACA call it “socialism” and warned of “death panels.” The reality is that it was a compromise within the ruling Congressional Democrats, who did not opt for a single payer system like Canada. They did not institute some Republican positions such as tort reform to keep medical malpractice costs down, nor did they allow insurance to be sold across statelines, something several doctors told me would have the greatest impact on costs.

Democrats like U.S. Rep. Baron Hill, Joe Donnelly and Brad Ellsworth voted for the reforms and now must defend them for the 2010 election. The Kaiser Family Foundation identified” immediate benefits for Indiana” that include tax credits for 84,400 small businesses; closing the Medicare Part D “donut hole” for 81,800 beneficiaries; and giving 103,000 early retirees a $5 billion temporary reinsurance program for those who lose benefits from former employers. Insurance companies will no longer be able to place lifetime limits on coverage impacting 3.8 million Hoosiers; it will protect 279,000 people who would be dropped from coverage upon illness; eliminating pre-existing conditions to bar people from insurance access; extend coverage to 21,000 young adults up to age 26; and $92.6 million federal dollars for insured Hoosiers.

It’s also important to note that the $517 million that Indiana hospitals were writing off last year was essentially picked up by government or spread out across the consumer pool. That’s why your health care costs were going up. The Congressional Budget Office predicted ACA would actually help with federal budget deficits, but I find it hard to believe this is a reliable forecast.

The real problem with the ACA in my view is that it’s extremely complicated with an array of mandates and subsidies. Some of them will work, others won’t and there will be a great deal of tweaking if Republicans don’t get their way for an outright repeal, which will be extremely difficult to do.

During the debate in 2009, both U.S. Sen. Dick Lugar and Democrat Evan Bayh urged President Obama to take a more “incremental approach.” Bayh suggested breaking the bill up into sections, passing legislation most agreed on.

The bill is good news for Wishard; only six percent of its patients typically have commercial health insurance. “With over $200 million worth of uncompensated care going through our system, the supplemental dollars that we receive are significantly less than that directly for health care related services,” said Daniel Sellers, chief financial officer and treasurer for Health and Hospital Corporation.

But for the State of Indiana, there is a lack of details. In an Aug. 23 letter to Gov. Mitch Daniels, FSSA Secretary Anne Murphy and acting Insurance Commissioner Stephen A. Robertson stated, “The budget impact is potentially significant, and the state will have to identify a way to pay for the new ACA costs. Many of the requirements amount to unfunded mandates to states at a time when they can be least afforded. We still await the necessary federal guidance to move forward with our implementation.”

Gov. Daniels sees a “massive unfunded mandate” with a “big whopping bill coming to taxpayers.” He urged “free market” solutions.

Kevin Woodhouse, a partner specializing in health care issues at Ice Miller, explained, “Part of the cost will be paid by the federal government, but only part of it. There will be increased cost over the next 10 years under the health reform bill. There is no one way to avoid that.”

For Hoosier voters, it could come down to this:  What is it worth to cover a half a million people where the costs were hidden and what impact will it have on our tax bills? That’s both a moral values and fiscal question with no easy slogan to answer.

(The columnist publishes at

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