By John Krull
TheStatehouseFile.com

INDIANAPOLIS – The confused response to Indiana Gov. Mike Pence’s proposed plan to expand the state’s medical coverage for the poor shows how much Obamacare has changed the American political dialogue – and is likely to continue changing it.

John Krull, publisher, TheStatehouseFile.com
John Krull, publisher, TheStatehouseFile.com
Pence, a conservative Republican whose flirtation with running for president in 2016 has elevated his national profile, announced May 15 that he wanted to expand the Healthy Indiana Plan – HIP – so that it would provide health coverage to an additional 350,000 Hoosiers.

Commentary button in JPG – no shadowPence and other conservatives tout HIP as a market-driven answer to Medicaid. Perhaps the biggest difference between HIP and Medicaid is that HIP requires the poor to have “some skin in the game,” to use Pence’s phrase, by paying a nominal fee for the coverage. If the poor don’t have any skin to spare, they get shifted to another, more basic plan.

Because the Indiana governor has been such a loud and persistent critic of President Obama’s health care reform efforts – and because his contemplation of a presidential run has been about as subtle as a Madonna concert’s allusions to sex – Pence’s proposal drew national attention.

Curiously, though, neither the criticism nor the praise seemed to be defined along partisan lines.

Forbes magazine and the conservative think tank the Heritage Foundation labeled Pence’s plan a mistake and said the Hoosier governor should walk away from Obamacare in all forms. The Washington Times, a conservative newspaper, praised Pence for coming up with a GOP-friendly alternative to Obamacare.

On the other side, The New York Times and The Washington Post saw Pence’s proposal as a sign that yet another GOP governor was quietly acknowledging reality and softening his opposition to Obamacare.

Still others made the argument that distinguishing between HIP and Medicaid was the same as establishing a distinction without much of a difference.

There doubtless is some truth to all of these arguments, but they all, to a certain degree, miss the most important point.

And that is that the president’s health care reform package has challenged everyone, Republican and Democrat alike, to think anew about how we provide medical care and how we pay for it.

I remember a conversation I had with a couple of doctors a year ago, not long after the president’s second inauguration.

Neither doctor was a fan of either the president or, in its particulars, Obamacare. Both men emphasized that they’d voted for Mitt Romney.

But they also both said that the president’s health care reform plan had done one essential thing. It had forced a national conversation about health, about costs and how about how we deliver medical care.

“I have to give Obama credit for that,” one doctor told me. “He made health care something politicians had to confront instead of something they struggled to avoid dealing with.”

The doctor was right.

If the federal government approves Pence’s proposed HIP expansion, it will extend health-care coverage to 350,000 Hoosiers.

But those 350,000 Hoosiers without meaningful health coverage didn’t just suddenly appear. They have been here for decades – along with 30 million to 40 million other Americans who didn’t have health insurance and for whom a major or lingering illness was an economic disaster in waiting.

Republicans such as Pence fought Obamacare with ferocity from the beginning, but their efforts to derail the president’s plan faltered in large part because they never advanced their own plan to meet the needs of those 30 million to 40 million citizens. They lost the national debate over health care because they offered only criticism, not an argument or an alternative.

Because Obamacare is likely to be an enduring reality – and because the enrollment and financial numbers for the program show it isn’t the disaster Republicans banked on it being – conservatives such as Pence now are grappling with creating alternatives to and refinements of the president’s plan.

Critics can and will carp that they’re joining the discussion a little late, but better late than never.

In part because Obama did force the conversation about health care, we Hoosiers – we Americans – finally are getting what we needed from the beginning.

A debate, and not a shouting match.

John Krull is director of Franklin College’s Pulliam School of Journalism, host of “No Limits” WFYI 90.1 Indianapolis and publisher of TheStatehouseFile.com, a news website powered by Franklin College journalism students.

Congressman Larry Bucshon, M.D. released the following statement regarding passage of H.R. 4031, the Department of Veterans Affairs Management Accountability Act of 2014, a bill to hold senior employees of the Department of Veterans Affairs (VA) accountable for negligent behavior like “secret” waiting lists and intentional backlog.

“The VA employs many dedicated Americans who every day serve their country and care for the well-being of our veterans. I have seen this first hand. During my residency, I worked at a VA Hospital alongside a staff dedicated to caring for our veterans to the best of their ability. However, as we have seen recently, there are bad actors and processes that are intentionally negligent and malicious to the men and women who have sacrificed their lives for our freedoms.

“Unfortunately, the current system is riddled with bureaucracies that serve as an impediment to remove or transfer VA senior executives. Many of these individuals are not being held accountable for their actions. And we’ve seen a lack of leadership from President Obama on the issue. This is unacceptable and our veterans deserve better.

“Today, we passed a common-sense accountability measure that the VA lacks. It’s simple, if a senior employee’s performance is negligent and warrants removal, the Secretary of the Department will have the authority to remove the staff member. In light of the President’s speech today, I sincerely hope he urges our Senate colleagues to pass this bill to protect our veterans immediately.”
Summary of H.R. 4031:

H.R. 4031 gives the Secretary of Veterans Affairs authority to remove an employee of the Senior Executive Service if the Secretary determines that the employee’s performance warrants removal. The Secretary can remove the individual from federal service entirely, or transfer him to a General Schedule position within the civil service system. Within thirty days of removing the individual, the Secretary must notify the House and Senate Committees on Veterans’ Affairs of the removal and the reason for it. H.R. 4031 provides that the employee’s removal shall be done in the same manner as the removal of a professional staff member of a Member of Congress.

BACKGROUND

Recent media reports have highlighted severe mismanagement and a lack of accountability across the Department of Veterans Affairs (VA). Reports of preventable veteran deaths, “secret” waiting lists intended to conceal the lengthy wait times for patients, and an increased claims backlog have corresponded with bonuses and positive performance reviews for VA management.

Congress established the Senior Executive Service (SES) in 1978 to “provide a government-wide, mobile corps of managers within federal agencies. The SES, comprising mostly career appointees who are chosen through a merit staffing process, is the link between the politically appointed heads of agencies and the career civil servants within those agencies. The creators of the SES envisioned it as a cadre of high-level managers in the government who would provide leadership for agencies across administrations and ensure productivity and efficiency within the government.”[1] Currently, a performance-based removal of an SES employee is a cumbersome, multi-step process. [2] H.R. 4031 authorizes the Secretary of Veterans Affairs to bypass the existing process and remove SES managers whose performance warrants it. The bill allows such employees to be removed in the same manner as a professional staff member of a Member of Congress.