Indiana's Medicaid experiment offers a conservative take on health reform

Linda Joyner, at 64, just got health coverage.

Uninsured for years, the former waitress signed up for Medicaid after Indiana expanded its program through the Affordable Care Act. But unlike millions of low-income Americans who've enrolled in the government plan since last year, Joyner is paying for her coverage.

Indiana, which has a conservative Republican governor and Legislature, is pioneering an experiment that requires low-income patients to contribute monthly to a special health account. Joyner chips in $12.33.

"It's the first thing I pay after the rent," she said during a recent visit to a clinic in this aging manufacturing town often billed as the RV capital of the world.

Charging poor people small premiums or fees for care — long favored by conservatives who contend that "skin in the game" engages patients in their health — has historically produced mixed results.

But at a time when Obamacare remains deeply unpopular among Republicans, the idea is attracting new interest as GOP governors seek ways to put a conservative stamp on expanding coverage. Indiana's experiment may provide a glimpse at where the health law is headed in some parts of the country.

"There are a lot of people who are looking really closely at what Indiana is doing," said Matt Salo, executive director of the National Assn. of Medicaid Directors.

Several states, including Arkansas and Iowa, have implemented cost-sharing requirements in their Medicaid expansions. GOP officials in Utah, Arizona, Ohio and elsewhere are reviewing the idea.

Health and Human Services Secretary Sylvia Mathews Burwell said the Obama administration, which must sign off on new cost-sharing requirements, was open to more proposals from Republican governors. "We welcome the conversation," she said, calling Indiana's Medicaid plan "a big deal and a very important deal."