Indiana Gov. Mike Pence (R) might have started a trend. No, not one involving a state-run news outlet (that didn't turn out so well -- quelle surprise), but rather a trend on Medicaid expansion. Pence announced Tuesday that he reached a deal with the Obama administration to launch Healthy Indiana Plan 2.0, his own distinct version of expansion.
From the Indianapolis Star:
"I believe Medicaid is not a program we should expand. It's a program that we should reform – and that's exactly what we're accomplishing," Pence said Tuesday in a speech at St. Vincent Health, announcing the plan's approval. "HIP 2.0 is not intended to be a long-term entitlement program. It's intended to be a safety net that aligns incentives with human aspirations."
Pence joins a handful of other GOP governors in accepting federal money to expand Medicaid coverage as part of the Affordable Care Act, but his plan is stamped with his conservative brand.
Most GOP governors haven't taken the expansion, citing worries about having to fund it in future years if federal funding dries up (not to mention it's part of Obamacare, which conservatives abhor). Two early exceptions included Govs. Chris Christie (N.J.) and John Kasich (Ohio), who previously accepted billions in federal money. Pence now joins them, but he's also different, in that he has negotiated with the Obama administration to attach personal responsibility to the expansion.
Poor adults will have to contribute to the cost of their health-care plan, which promotes healthy behaviors by linking them with the monthly payment amount. Quitting smoking means a lower payment. And failure to meet the co-pay could mean getting locked out of coverage, a feature that is unique to Indiana.
And it all comes at no cost to taxpayers, as hospital fees and cigarette taxes will cover the tab. Governors in Iowa and Michigan took similar approaches, emphasizing healthy behavior with some fees and time limits on coverage, but none of the provisions are as strict as Indiana's. Healthy Indiana Plan 2.0 could be the answer to the question of what the conservative approach to the Medicaid expansion in Obamacare actually looks like.
At this point, 28 states and the District of Columbia have opted to expand, with a handful of red states possibly adding to the total this year.
And Pence isn't just any GOP governor. He was known as a conservative's conservative during his time in the U.S. House of Representatives, and he's often included on the long list of possible 2016 presidential contenders. That suggests he could end up being a pivot point, paving the way for other GOP governors to make a similar choice. He is by far the most conservative of the GOP governors to engage the Obama administration over health care.
But his decision, of course, is not without conservative critics.
From The Federalist:
Merely engaging with Obamacare is going to earn you some enemies on the right. And Pence is sticking his neck out to some degree -- especially if he does want to run for president.
But he has also found a middle-ground way between leaving the federal money on the table, as Gov. Bobby Jindal has done in Louisiana, and taking the money without state-based reforms and tweaks, as Christie did in New Jersey. The Pence way could become a model not only for GOP governors, but also for Democratic governors such as Terry McAuliffe (Va.) who can't expand Medicaid without getting a Republican legislature on board.
And if he does run for president (something that appears less than likely, but certainly is possible/plausible), Pence could have a better story to tell than his opponents -- one that has an element of compassion, experimentation at the state level and personal responsibility.
It could be a winning formula that others can't pass up.