Indiana expanded Medicaid coverage under then-Gov. Mike Pence. But it also added some rules and costs for those eligible. From Think Progress:

While Pence’s plan theoretically extended Medicaid coverage to some 590,000 individual residents so far, the majority of them have seen their coverage cut back or canceled according to a new report on the plan’s outcomes. While just 13,550 people were kicked off the Medicaid roles in that time, another 287,000 got knocked down into a reduced service category that does not include vision or dental coverage. More than 46,000 never enrolled to begin with.

Why is Pence’s plan delivering so much less actual insurance coverage to so many fewer actual human beings than it was supposed to? The Vice President felt it was important that people with incomes below 139 percent of the federal poverty level have “skin in the game” for their health care. He imposed premiums on this economically vulnerable population, a policy directly at odds with the core purpose of the Medicaid program as it has existed for decades.

Turns out these poor families can’t afford to pay insurance premiums, even on the income-based sliding scale from $1 to $100 per month established in Pence’s bill. A full 324,840 people failed to make at least one of these payments in the relevant period, causing most of them to lose access to affordable dentistry and eye care — and knocking several thousand off of the insurance rolls entirely.

The Arkansas legislature just adopted Gov. Asa Hutchinson’s plan to toss 60,000-plus people making above 100 percent of the federal poverty level from the Medicaid expansion. He’s expressed confidence that that group will be happy to come up with additional small premiums or otherwise adapt to some less expensive (and less thorough) coverage of plans in the federally subsidized insurance marketplace.


Maybe the working poor in Arkansas will work harder and smarter than those in Indiana.

The Arkansas changes must be approved by the new Medicaid chief. Approval is expected forthwith, particularly the work requirement and additional payments. Skin in the game is the new mantra. Flayed skin might be the reality.