Indiana should create state health exchange

South Bend Tribune

It took some time, but Indiana finally began participating in the Affordable Care Act to the benefit of some 350,000 low-income Hoosiers without insurance.

In late January, after months of back and forth between the Pence administration and federal officials, the waiver for the Healthy Indiana Program, or HIP 2.0, was approved, with coverage beginning Feb. 1.

Even those who took issue with the governor’s refusal to expand traditional Medicaid, or who complained about the participant contributions that the consumer-driven plan requires, were relieved that insurance would finally be available to more people in a state with a mountain of serious health problems.

But a decision by the Supreme Court later this year in the case King v. Burwell could jeopardize future prospects for low-income Hoosiers who are eligible for subsidies. If the latest challenge to the ACA is successful, it could end premium subsidies in all the states where the federal government runs the insurance exchanges. That includes Indiana, which declined to create a state exchange in opposition to the ACA.

A recent article by the Center for Public Integrity notes that lawmakers in at least nine states — including Indiana — have proposed measures to jump-start the process of switching from the federal to a state exchange.

State Sen. Karen Tallian, D-Portage, introduced a bill that requires the state “to design, implement and administer the Indiana health exchange in accordance with federal law.”

As she explained in a recent phone interview, Senate Bill 417 is an attempt to head off the problems that would be created by a Supreme Court ruling striking down federal subsidies.

Although SB 417 never received a hearing and is dead for all practical purposes, Tallian says the issue itself is still alive, with a hearing scheduled to discuss the subject. She attributes the scheduling of the hearing to the realization among members of the Appropriations Committee of the huge fiscal impact on the state “if this Supreme Court case goes the wrong way.”

The possibility that the federal subsidies will be struck down is reason enough for Indiana to create its own exchange. But there are other reasons, as pointed out in a recent column by Dr. Richard Feldman, a former state commissioner of health. In urging Indiana to do what 16 states have already done, Feldman wrote that the advantages include better control over which insurance companies qualify to participate in the exchange and the ability to target benefits to address such major Indiana health issues as infant mortality and diabetes.

Indiana has a habit of acting on critical issues — when it does act — in excruciatingly slow fashion. For the sake of countless Hoosiers and their future health care needs, it’s time for officials to pick up the pace and get started on a state health exchange.

This was distributed by Hoosier State Press Association. Send comments to