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Cost Did Not Keep Hoosiers From Signing Up For Medicaid


Hoosiers did not stop signing up for Indiana's Medicaid expansion even though they had to pay into a health savings account. That’s according to new research from three Indiana University professors.

When Indiana expanded Medicaid in 2015, it was the first state to require that those insured had to contribute to the Healthy Indiana Plan. Participants had to pay a small percentage of their income into a Personal Wellness and Responsibility, or POWER, account as part of the plan.

"Some would call it innovative. Others would call it a complex model," said Kosali Simon, a professor at Indiana University and one of the authors of the paper.

Health insurance advocates worried the requirement would deter low-income residents from signing up for HIP. The IU researchers found that wasn't the case. Enrollment in HIP increased in Indiana, just as enrollment increased in other states that expanded Medicaid, according to the study.

Enrollment was lower in Indiana, however, than in Kentucky, Michigan, Ohio, and Illinois, neighboring states that also expanded Medicaid. Unlike Indiana, those states do not have a requirement to pay into a health savings account.

Simon said more data is needed before researchers can say contribution requirements had anything to do with lower regional enrollment.

"We certainly expect when somebody is asked to pay for something there will be fewer people who decide to do that," she said. "It is definitely something we want to look into."

Proof that paying into a health savings account doesn't deter Medicaid enrollment could have national implications, according to the researchers. Vice President Mike Pence was Indiana’s governor when Medicaid expanded in the state. And one of HIP's creators, Seema Verma, is now the administrator of the Centers for Medicare and Medicaid Services.

Pence and Verma have said they want to push for Medicaid expansions like HIP that rethink the traditional health care model.

"It's clear you get substantial coverage effects," Simon said. "Now we want to see can you actually show improvements."

Lauren is the digital editor for Side Effects Public Media and WFYI in Indianapolis. She was previously an investigative reporter and is the co-host of the podcast Sick. She can be reached at