Indiana health insurance
Hoosier State: home to declining health rankings and little appetite for ACA
By Carla Anderson
August 13, 2014
Access to health care providers, immunization rates, high school graduation rates and insured rates all contribute to the health status of residents in a given area. See how Indiana compares to other states in overall health and consider whether expanded health insurance coverage through the Affordable Care Act can play a role in boosting the state’s overall health.
Indiana health ratings
The Commonwealth Fund’s 2014 Scorecard on State Health System Performance ranked Indiana 43rd in overall health among the 50 states and the District of Columbia. Indiana dropped 12 places from 2009. See Indiana’s Scorecard to see what indicators make up the overall ranking.
Indiana is ranked 41st in America’s Health Rankings from 2013, the most recent data available. Public health highlights for Indiana include high immunization rates among adolescents and low rates of infectious disease. The state’s health challenges include many smokers, high levels of air pollution, and low immunization rates for children.
The 2014 edition of Trust for America’s Health also ranks various public health measures; see Key Health Data About Indiana.
If statewide data is too broad, get county-by-county health rankings for Indiana from the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin.
Indiana and the Affordable Care Act
When the Affordable Care Act was passed in 2010, Indiana’s senators and representatives voted along party lines, with former Sen. Evan Bayh voting yes, former Sen. Richard Lugar voting no, and representatives voting 5-4 in favor of the measure. Currently, Indiana’s House delegation is dominated by Republicans, and its Senate seats are split between the parties.
Both former Gov. Mitch Daniels and current Gov. Mike Pence oppose the ACA.
Indiana uses the federally facilitated health insurance exchange, and it has not supported Medicaid expansion as envisioned by the ACA. Indiana is, however, seeking a federal waiver to use funds intended for Medicaid expansion to enhance the Healthy Indiana Plan. The federal government rejected the state’s first proposal, and a second proposal is pending as of August 2014.
How the ACA is helping Indiana residents
Through the ACA, about 416,500 nonelderly, uninsured Indiana residents qualify for financial help to gain medical insurance – either through Medicaid or premium subsidies to purchase private insurance through the marketplace.
From 2013 to mid-2014, Indiana’s uninsured rate dropped from 15.3 percent to 15.0 percent. The failure to implement a state-run exchange (in many states, an indication of ACA opposition) and the delay in any sort of Medicaid expansion are factors in the very modest decline.
The average change in the uninsured rate was -2.2 percentage points among states that didn’t implement a state-run marketplace or expand Medicaid, or that implemented only one of those measures.
Indiana enrollment in QHPs
According to the Kaiser Family Foundation, 132,423 of 525,000 potential market enrollees in Indiana – 25.2 percent – signed up a qualified health plan (QHP) during 2014 open enrollment. Nationally, 28 percent of potential enrollees signed up for QHPs.
Competition among insurers through the marketplace was limited during 2014 open enrollment. MDWise, Coordinated Care, Physicians Health Plan of Northern Indiana and Anthem participated in the marketplace. However, only one or two insurers offered policies in about two-thirds of the state’s 91 counties.
Medicaid expansion, as enacted by the ACA, extends Medicaid eligibility to low-income adults up to 138 percent of the federal poverty level. While Indiana is pursuing an alternative approach, it has yet to expand Medicaid – meaning 291,000 people are excluded from the Medicaid program and 182,000 people in the coverage gap.
Learn about available Medicaid coverage in Indiana.
Other ACA reform provisions
The Affordable Care Act established the Consumer Operated and Oriented Plan (CO-OP) Program to encourage competition and consumer choice. Through this federal loan program, 24 CO-OPs were set up as of January 2013. However, no CO-OP plans were created in Indiana.
Does Indiana have a high-risk pool?
Before the ACA reformed the individual health insurance market, applications were medically underwritten in nearly every state, including Indiana. As a result, people with pre-existing conditions were often ineligible to purchase private plans, or were only able to get policies that excluded their pre-existing conditions or charged them significantly higher premiums for comprehensive coverage.
The Indiana Comprehensive Health Insurance Association (ICHIA) was created in 1982 to provide an alternative for residents who were unable to obtain coverage in the private market because of their medical history.
Under the ACA, all new health insurance policies became guaranteed issue starting on January 1, 2014. This aspect of healthcare reform meant that plans in the individual market could be purchased regardless of medical history, making high risk pools largely obsolete. ICHIA stopped enrolling new members at the end of September, 2013. They had originally planned to cease operations and terminate all policies at the end of 2013, but the glitches in Healthcare.gov made it difficult for members to enroll in an exchange plan by mid-December. The Indiana Insurance Commissioner extended ICHIA coverage until January 31, 2014 in order to give members another month to secure new plans. Coverage was extended until April 30, 2014 for members with HIV, and until the end of 2014 for the twelve members with end stage renal disease.
Indiana’s state-level health legislation
Here’s what’s happening in Indiana at the state level with healthcare reform: