Seth Freedman (
Lilliard Richardson is a professor in the School of Public and Environmental Affairs, Indiana University-Purdue University Indianapolis.
Health Aff (Millwood). 2018 Jun;37(6):936-943. doi: 10.1377/hlthaff.2017.1596.
In 2015, Indiana expanded eligibility for Medicaid under the Affordable Care Act (ACA) through a unique waiver, Healthy Indiana Plan 2.0, which requires enrollees to make monthly contributions to an account that is similar to a health savings account to receive full benefits. Enrollees who fail to make these contributions receive less generous benefits if their income is below the federal poverty level, and if it is 100-138 percent of poverty, they are locked out of coverage for six months. We estimated the impact of this expansion on coverage rates and compared the effects to results from other states that expanded Medicaid after 2014. We found that Indiana's coverage gains (relative to pre-ACA uninsurance rates) were smaller than gains in neighboring expansion states, but larger than those in other states. These results imply that while one potential reason for Indiana's lower gains relative to neighboring states was its cost-sharing requirements, expansion led to unquestionable coverage gains in the state.
2015 年，印第安纳州通过一项独特的豁免权，即《平价医疗法案》（ACA）下的“健康印第安纳计划 2.0”，扩大了医疗补助的资格范围。该计划要求参保人每月向类似于健康储蓄账户的账户缴款，以获得全额福利。如果收入低于联邦贫困线，未能缴纳这些款项的参保人将获得福利较低；如果收入在贫困线的 100%到 138%之间，则将被封锁六个月的保险。我们评估了这一扩张对覆盖范围的影响，并将结果与 2014 年后扩大医疗补助的其他州进行了比较。我们发现，印第安纳州的覆盖范围增长（相对于 ACA 前的未保险率）低于邻近扩张州的增长，但高于其他州。这些结果表明，虽然印第安纳州的增长相对较低的一个潜在原因是其共付要求，但扩张确实在该州带来了无可争议的覆盖范围增长。
