The Healthy Indiana Plan 2.0 is now just over a year old. It’s Indiana’s version of the expanded Medicaid program offered by the Affordable Care Act. But unlike traditional Medicaid, Indiana received waiver approval for an alternate system that incorporates personal responsibility and consumer-driven health care. Here’s the theory: if one is financially engaged, it encourages a sense of ownership, personal empowerment, and responsible utilization of medical services.

Waiver approval was important since the expansion is almost entirely funded by the federal government. Before the expansion, Indiana Medicaid covered only low-income pregnant women, children, the disabled and parents below 24 percent of poverty; childless adults were excluded. Now, HIP 2.0 covers all adults below 138 percent of poverty. That’s nothing short of a sea change for Indiana.

I support the HIP 2.0 approach. It adds a small measure of financial responsibility but does not appear to discourage participation by the eligible poor. Actually, the personal financial contribution is negligible for the vast majority of HIP participants. If below the poverty level, participants can opt not to contribute to a HSA-like POWER account and pay small co-pays for medical services other than preventative services. If participants do contribute to the POWER account, they receive enhanced services and have no co-pays. The typical contributions are from $1 to a few dollars per month for the vast majority of participants. If between 100 to 138 percent of poverty, the personal contributions are moderately more substantial.

The HIP 2.0 program has been a great success and well received by patients. The Pence administration has aggressively encouraged participation through effective outreach; approximately 370,000 people are now covered, including 270,000 new participants and more than 5,300 new health-care providers. Seventy percent of participants have chosen to contribute to a POWER account. Emergency department visits by HIP recipients formally on Medicaid are reported to be down 40 percent, and patients appear more aware of the cost of medical care. HIP 2.0 has also been a godsend to Indiana hospitals, important economic and medical-care anchors for our communities, which are now seeing significant reductions in uncompensated care while facing reduced reimbursements from Obamacare.

Feldman is director of medical education and residency training at Franciscan St. Francis Health and a former Indiana State Health Commissioner.

Matt Lloyd

Deputy Chief of Staff, Communications and Strategy

Governor Mike Pence

317-864-0884 (cell)

Scott Roberts for www.theindianalawyer.com

The 7th Circuit Court of Appeals decided a case that dragged on in the federal court system for nine years Thursday.

The court said the district court made no errors in deciding several complaints from Tom and Marla Simstad, who said Lake County Plan Commission members held a grudge against them after they supported another candidate in the 1996 county commissioner election and deliberately slowed the process of their planned subdivision. Because the process was slowed so much, the Simstads had to give up on the project in 2006 and sell the land at a loss to avoid bankruptcy.

The Simstads filed their initial complaint in November of 2007 and in April of 2008, the defendants filed a motion to dismiss a complaint and a stay of discovery. The case sat until Sept. 30, 2010 when the court issued an order dismissing some claims, but not all. Later in 2010, the court noticed no one was doing anything in the case, and set new deadlines. Those passed as well and it was December of 2014 before the case finally went to trial.

The district court dismissed the Simstads’ first amendment complaint, finding no connection between the 1996 election and the approval process for the project. It also dismissed the Simstads’ state law claim for failure to provide timely notice under the Indiana Tort Claims Act and tossed an individual capacity claim against a plan commission member for lack of evidence. A jury found for the defense in an equal protection claim.

The Indiana Supreme Court already considered the ramifications of the commission’s refusal to approve the project, ruling the commission was not immune from sanctions, but had not acted in bad faith because the settlement agreement could not bind the commission to approve the project in violation of Indiana’s Open Door Laws. The public has final approval.

The defendants in the case never renewed a motion on any theory of preclusion in the case, however, and the 7th Circuit can still decide on the case.

The 7th Circuit found no abuse of discretion in the district court’s decision to permit the defendants to withdraw their deemed admissions and any prejudice was mitigated by reopening discovery or them alone.

The court agreed there was no evidence members of the plan commission knew the Simstads at all or had any grudge against them whatsoever. There was only one statement that Tom Simstad made, and that could not be used as evidence by itself.

Equal protection and state law claims were also dismissed in the case for lack of evidence, and the Simstads’ “cat’s paw” liability does not stand up in a municipal context.

The case is Thomas Simstad et al v Gerald Scheub et al, No. 15-1056.