Republican legislative leaders in Indiana are warning that repealing the Affordable Care Act could unravel a program for poor residents that Vice President Mike Pence implemented as governor, a conservative blueprint for expanding Medicaid under the federal law.
Indiana House Speaker Brian Bosma and GOP Senate leader David Long said this week that tens of thousands of poor people could lose their insurance if Republicans in Washington enact some of the ideas they're discussing for repealing former President Barack Obama's signature health care law.
"It's reality hitting home," Long, a Republican from Fort Wayne, said Wednesday. " ... The issue of the working poor is real. It's not going to be easy."
Pence has been a persistent critic of the law since serving in Congress before he became Indiana governor. But one of his legacy achievements after becoming governor in 2013 was an expansion of Medicaid in the state, which overwhelmingly relies on money made available under the Affordable Care Act.
The program, called HIP 2.0, has covered roughly 400,000 people and was designed by Seema Verma, a key health policy adviser to Pence who is President Donald Trump's pick to oversee the Centers for Medicare and Medicaid Services. It also counts on the federal government for at least 90 percent of its funding.
Indiana recently launched an ad campaign to promote the benefits of the plan. A billboard near the state capitol that previously carried an ad criticizing Pence was papered over with an ad for HIP 2.0.
In order to enact his own conservative vision for health care in Indiana, Pence sought and got a federal waiver. He wanted to make sure poor people demonstrated personal responsibility and had "skin in the game" by paying small monthly fees for coverage. It's an approach that had been touted as a model other Republican-controlled states could adopt. A similar approach was adopted in Kentucky under GOP Governor Matt Bevin.
A spokesman for the vice president did not respond to a request for comment.
On Wednesday, Pence told ABC's "Good Morning America" that "we don't want anyone to fall through the cracks," especially not "the most disadvantaged citizens among us."
But changes under consideration by congressional Republicans would significantly reduce federal funding for Medicaid and subsidize private insurance, creating funding gaps for states and threatening a loss of coverage for many participants, according to a report by the consulting firms Avalere Health and McKinsey & Company.
States like Indiana that expanded Medicaid would face the deepest cuts.
Some Republican governors have voiced concern that a repeal of the ACA would have a disastrous effect on poor people, some of which are Trump supporters.
Pence's handpicked replacement, Governor Eric Holcomb, has yet to weigh in on his preference. A spokeswoman for the governor did not immediately respond to a request for comment.