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Indiana health insurance

Medicaid expansion drives down Hoosier State uninsured rate

Access to healthcare 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 is playing 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 and placed in the bottom five for three health indicators, including total single premium per enrolled employee at private-sector establishments that offer health insurance. See Indiana’s Scorecard for more details on what makes up the overall ranking.

Indiana ranked 41st in America’s Health Rankings for 2014, the most recent data available. The state fared poorly and ranked in the bottom 10 for 10 measures, including public health funding, availability of dentists, preventable hospitalizations and air pollution. Public health highlights that positively impacted Indiana’s rank include high immunization rates among adolescence, a low number of children living in poverty, and a relatively small disparity in health status.

The 2015 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, but 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.

Indiana uses the federally facilitated health insurance exchange.

How Obamacare 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. But Medicaid expansion took effect in early 2015, and when the uninsured rate was recalculated based on data from the first half of 2015, Indiana’s uninsured rate had fallen to 11.1 percent.

From 2013 to 2015, the average change in the uninsured rate was -5.3 percentage points among states that didn’t implement a state-run marketplace or expand Medicaid, or that implemented only one of those measures. Indiana’s total drop as of mid-2015 was 4.2 percentage points, but Medicaid expansion had only been in effect for a few months at that point, and it’s likely we’ll see a further reduction in the uninsured rate by 2016.

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.

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.

Nine insurance companies sold individual health insurance through the Indiana marketplace in 2015: Anthem BCBS, Coordinated Care, and Physicians Health Plan all returned from 2014, and All Savers, Caresource, IU Healthplans, MDwise Marketplace, Southeastern Indiana Health Organization, and Time/Assurant are new for 2015. Note that not all insurers offer plans in all counties.

For 2016, eight of those carriers are returning to the exchange, but Time/Assurant has exited the individual health insurance market nationwide. For plans sold in the exchange, the weighted average rate increase in Indiana for 2016 is just 0.7 percent.

IN health insurance carriers

All but one of Indiana’s individual market carriers sell plans both on and off the exchange. Only one – UnitedHealthcare – sells exclusively outside the exchange (although their subsidiary, All Savers, sells plans on the exchange.

Here’s a full list of Indiana’s individual market health insurance carriers:

  • All Savers
  • Anthem Blue Cross Blue Shield (has about 65 percent of the on-exchange market share)
  • Care Source
  • Celtic
  • IU Health Plans
  • MDwise Marketplace, Inc.
  • Physicians Health Plan of Northern Indiana, Inc.
  • Southeastern Indiana Health Organization, Inc.
  • United Healthcare Life Insurance Company (off-exchange only)

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 starting 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 August 2015, total Indiana Medicaid/CHIP enrollment in Indiana increased by 25 percentrom 1,120,674 to 1,404,549.

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, 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 (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 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.

Indiana’s state-level health legislation

Here’s what’s happening in Indiana at the state level with healthcare reform:

HB 1479 was introduced in January 2015. This bill would have prohibited certain actions related to state insurance officials enforcing or implementing the Affordable Care Act. It would have required a tax deduction for those paying an ACA tax penalty. The bill did not pass the House Ways and Means Committee.

Medicare enrollment in Indiana

In 2015, Indiana Medicare enrollment reached 1,141,916, about 17 percent of the state’s population and consistent with the percentage of people enrolled in Medicare across the U.S. Historically, 80 percent of Indiana Medicare recipients qualify based on age alone and 20 percent qualify due to a disability.

Indiana ranks 15th in overall Medicare spending with $9.7 billion per year. Medicare pays about $9,842 annually per Indiana enrollee.

Indiana Medicare recipients who want additional benefits beyond what original Medicare offers can instead select a Medicare Advantage plan. Twenty-four percent of Indiana Medicare beneficiaries are enrolled in a Medicare Advantage plan instead of traditional Medicare. Nationwide, 32 percent are enrolled in Medicare Advantage plans.

Medicare Part D plans are also available to Indiana Medicare enrollees who want stand-alone prescription drug coverage. More than half (52 percent) of Indiana Medicare enrollees have stand-alone Rx coverage compared with 43 percent nationwide.