Sun Sentinel Palm Beach Edition
Trump-favored Medicaid setup may make care less affordable
WASHINGTON — Even as the Trump administration pushes to make Medicaid enrollees pay a greater share of their health care costs, new research suggests this strategy may prevent many poor patients from getting needed care.
An independent study of Indiana, which has helped pioneer the strategy of charging Medicaid patients, identified lower rates of health coverage in the state than in neighboring states that do not impose the same costs.
And a second study of the state found that lowincome Indiana residents have more problems paying medical bills and are more likely to delay care because of cost than in neighboring Ohio, which does not impose the same cost-sharing requirements.
“This may be circumstantial evidence,” noted Dr. Benjamin Sommers, a Harvard University researcher who co-authored the second study. “But there are certainly enough red flags to say that this approach may not be working the way it was intended.”
Both studies were published in the journal Health Affairs.
Indiana’s Medicaid program has been held up for years as a model by conservatives, who contend that charging poor people small premiums or fees for care — often called “skin in the game” — engages patients in their health.
Seema Verma, whom President Donald Trump tapped to oversee Medicare and Medicaid and who helped develop the Indiana program before coming to Washington, has encouraged other states to implement initiatives to place conditions on Medicaid coverage for able-bodied adults.
“Every American demany serves the dignity and respect of high expectations,” Verma told a gathering of state Medicaid directors in Washington last year, in which she also endorsed efforts by some states to require Medicaid enrollees to work.
Verma declined through a spokeswoman at the Centers for Medicare and Medicaid Services to comment on the new Indiana research.
Indiana’s Medicaid strategy — known as the Health Indiana Plan, and later HIP 2.0 — imposes a complex series of cost-sharing requirements on patients in the program.
Patients must contribute to a health savings account used for their medical expenses. Monthly contributions, based on income, range from $1 to $30.
If patients make the contributions, medical care is essentially free. People can even lower their contributions by getting recommended preventive care, such as cancer screenings.
If patients don’t contribute, however, they lose dental and vision coverage and must make small co-pays when they see a doctor or fill a prescription.
For years, Indiana officials, including Verma, contended that the strategy had broad participation from Medicaid enrollees.
But a growing body of evidence has shown that Indiana enrollees do not make the required contributions.
One of the new studies, which was based on a survey of low-income adults in Indiana, Ohio and Kansas, found that only about a third of Indiana adults eligible for HIP 2.0 were contributing to the accounts.
About 31 percent of those who were not making the payments said they could not afford them; another 21 percent said they did not think the payments were worth it; and 19 percent said they were confused by the cost-sharing requirement.
At the same time, the researchers found that substantial numbers of lowincome residents in Indiana reported trouble accessing care.
More than 30 percent reported that they delayed care because of cost, and 34 percent said they had trouble with medical bills.
In neighboring Ohio, by contrast, 25 percent of lowincome residents said they delayed care, and 29 percent said they had trouble with medical bills.
Ohio, unlike Indiana, undertook a more traditional expansion of its Medicaid program that does not put the same cost-sharing requirements on poor patients.