April 15, 2017

PAMPHLETS IN THE GAME?:

Pence's Medicaid experiment confounds expectations on the left and right : The program, which requires enrollees to contribute to their care, has emerged as a national model thanks to Pence's growing influence. (RACHANA PRADHAN 04/15/17, Politico)

When former Indiana Gov. Mike Pence embraced Obamacare's Medicaid expansion with conservative twists -- such as requiring enrollees to contribute to their care -- critics lamented poor people would be locked out while backers cheered the program's focus on personal responsibility.

Neither side's expectations were quite borne out. Two years later, as the program emerges as a national model thanks to Pence's role in the Trump administration, the reality on the ground shows what happens when political philosophy collides with the practical challenges of providing health care to tens of thousands of people, many of them in crisis.

Advocates for the poor in Indiana argue that liberal fears of depressed enrollment were overblown. More than 400,000 Hoosiers are enrolled, despite state requirements that low-income residents make nominal monthly contributions to their care or face stiff penalties.

Likewise, Republicans' contention that the system would promote personal responsibility and prod beneficiaries to ration their care and make better decisions about what treatments to seek also turned out to be overly optimistic.

By all accounts, the expansion -- known as the Healthy Indiana Plan 2.0 -- has made a difference. Health officials in Scott County, Ind., a poverty-stricken community about 30 miles from Louisville, Ky., paint a picture of a program that's bolstered a patchy social safety net -- especially during a major HIV outbreak triggered by the opioid epidemic -- without bankrupting the Hoosier State or punishing enrollees. [...]

If the liberal specter of a punitive system pushing out enrollees hasn't quite materialized, neither has conservatives' vision of a market-like system where patients with "skin in the game" make hard choices about their own health spending. That's because family members, health workers and nonprofits are helping cover their out-of-pocket costs.

"With some people, I think [personal responsibility] might be a little bit lost," Sanders said in her office at the Scott County Partnership, a nonprofit. "We try and do what we can in the little bit of time we have with them. But you can only give them so many pamphlets."

Try giving them money.

Posted by at April 15, 2017 8:35 AM

  

« JUST APPLIED DARWINISM: | Main | WHO KNEW YOUR CANDIDATE COULD BE LESS POPULAR THAN HILLARY/DONALD?: »