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Indiana health insurance

Hoosier State health rankings steady as uninsured rate falls

Mike Pence is on the ticket as Donald Trump’s running mate, for the 2016 U.S. presidential election, putting Indiana in the national spotlight.

As such, many may be curious about the state’s public health, its approach to healthcare reform, and other factors that contribute to its residents well-being.

See how Indiana compares to other states in overall health and consider whether expanded health insurance coverage through the Affordable Care Act is playing a role in boosting the state’s overall health.

Indiana health ratings

The Commonwealth Fund’s 2015 Scorecard on State Health System Performance held steady with Indiana once again ranking 43rd in overall health among the 50 states and the District of Columbia.

The state ranked in the third and fourth quintile for all categories: Access, Prevention & Treatment, Avoidable Hospital Use & Cost, Healthy Lives, and Equity. The state did not place in the top 10 for any one indicator; however, it never placed last either. See Indiana’s scorecard for more details on what makes up the overall ranking.

Indiana ranked 41st in America’s Health Rankings for 2015. As it did in The Commonwealth Fund Scorecard, Indiana earned lower marks for its percentage of uninsured individuals, coming in at 31st. The Hoosier State placed 48th for public health funding and 36th for policy, which includes the following measures: Lack of Health Insurance, Immunizations Children, Immunizations Adolescents, and Public Health Funding.

The 2016 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.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.

How Obamacare is helping Indiana residents

Under the ACA, Indiana has a federally facilitated exchange, which means its residents use HealthCare.gov to purchase health insurance plans that qualify for subsidies. The state initially did not expand Medicaid but later opted to do so, and expansion took effect in early 2015.

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. When the uninsured rate was recalculated based on data from the first half of 2015, following Medicaid expansion, Indiana’s uninsured rate had fallen to 10.8 percent – below the national average.

2017 rates, plans available in Indiana

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.

But Indiana residents had many more choices on the federal marketplace for 2015. The number of insurers more than doubled, from four to nine. And the number of available plans increased from 278 to 975.

When 2017 open enrollment begins, Indiana’s exchange will include fewer health insurance carriers once again. The five remaining will include:

  • Anthem BCBS
  • CareSource Indiana
  • Celtic
  • Indiana University Health Plans
  • MDWise

Aetna had filed rate proposals to join Indiana’s exchange, but the carrier announced in August that it would not expand into any new exchanges for 2017.

Indiana’s individual market will not include any PPO options for 2017. With the exception of Celtic’s on-exchange EPO and Anthem’s on- and off-exchange POS, all other carriers have only filed rates for HMO plans.

Rates for 2017 have been approved by Indiana and average 18.5 percent.

Indiana enrollment in qualified health plans

According to the Kaiser Family Foundation, 132,423 of 525,000 potential market enrollees in Indiana – 25.2 percent – signed up qualified health plans (QHPs) through Indiana’s health insurance exchange during 2014 open enrollment. Nationally, 28 percent of potential enrollees signed up for QHPs.

On March 31, 2016, Indiana’s effectuated exchange enrollment was 168,884 – nearly 83 percent of these enrollees were receiving premium subsidies that averaged $259 per month.

The Affordable Care Act in  Indiana

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.

Indiana uses the federally facilitated health insurance exchange HealthCare.gov. And while both former Gov. Mitch Daniels and current Gov. Mike Pence oppose the ACA, Pence did push for – and get – federal approval to expand Medicaid using a waiver to enhance the Healthy Indiana Plan. The federal government rejected the state’s first proposal, but a second proposal was approved in January 2015, and expanded coverage was in effect by February 2015.

Gov. Pence is the Republican Party’s nominee for Vice President of the United States in the 2016 election. In 2016, his replacement will be elected – either Republican Eric Holcomb or Democrat John Gregg.

Indiana Medicaid

Medicaid expansion, as enacted by the ACA, extends Medicaid eligibility to low-income adults up to 138 percent of the federal poverty level. Indiana did not expand Medicaid in 2014, but their second waiver proposal was approved by CMS in January 2015, paving the way for Medicaid expansion to begin in February 2015.

Prior to that, 291,000 people with incomes up to 138 percent of the poverty level were excluded from the Medicaid program and 182,000 people were in the coverage gap.

From 2013 to June 2016, average monthly Indiana Medicaid/CHIP enrollment in Indiana increased by 31 percent – an increase of 349,336 enrollees.

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, 12 had announced their closure by November 2015. 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 (now terminated) 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 12 members with end stage renal disease.

Medicare enrollment in Indiana

In 2015, Indiana Medicare enrollment reached 1,150,553, about 17 percent of the state’s population and consistent with the percentage of people enrolled in Medicare across the U.S. 82 percent of those individuals qualified based on age alone, while the other 20 percent were eligible due to a disability.

As of 2009, Indiana ranked 15th in overall Medicare spending with $9.7 billion per year. Per Indiana enrollee, IMedicare spends about $9,141 per year – higher than the national average of $8,970.

Indiana Medicare recipients who want additional benefits beyond what original Medicare offers can instead select a Medicare Advantage plan. In Indiana, 23 percent of Medicare beneficiaries are enrolled in a Medicare Advantage plan instead of traditional Medicare compared with 31 percent nationwide.

Medicare Part D plans are also available to Indiana Medicare enrollees who want stand-alone prescription drug coverage. More than half (53 percent) of Indiana Medicare enrollees have stand-alone Rx coverage compared with 45 percent nationwide.

Other recent health reform legislation at the state level includes: