The U.S. Department of Health and Human Services set a Sunday deadline for public comment on the Republican governor's idea to substitute a high-deductible health insurance-like program for the no-cost Medicaid access envisioned by the Affordable Care Act.
Through Friday, just 15 comments had been received by HHS. That's a far cry from the hundreds of thousands of federal comments Americans submitted last week on the issue of net-neutrality, or barring Internet service providers from charging extra fees to view different types of content.
After the deadline, the public comments will be reviewed by federal health officials and could affect whether HIP 2.0 wins approval.
A majority of the comments submitted so far are anonymous and about evenly divided between HIP 2.0 supporters and people who believe Indiana simply should expand Medicaid eligibility, instead creating its own program.
"I do not understand why Republicans continue to object to affordable health care coverage for all. It is embarrassing to be a citizen of a state that does not see the wisdom in accessibility to medical care for all," writes commenter 201288. "I believe access to affordable health care is a basic human right in any 'civilized' nation. Expanding Medicaid is the best solution to what ails Indiana."
However, commenters 201310 and 201326 acknowledge that given Indiana's conservative political climate, HIP 2.0 is the most realistic solution for extending health coverage to low-income Hoosiers.
"The Healthy Indiana Plan has been one of the most successful Medicaid waiver programs in the state of Indiana and has served Hoosiers well since 2008," said commenter 201310. "We're all aware that no program is perfect, but I believe that this will become the model for all of the other states who have so far refused to participate in the Medicaid expansion program."
Formal letters of support also have been submitted by the Indiana Minority Health Coalition and Mental Health America-Indiana.
Both groups said they back any effort to extend health coverage to currently uninsured Hoosiers.
A link to to the comment submission website is posted at nwi.com, or can be reached by searching "Section 1115 Demonstrations" at medicaid.gov, clicking on the demonstrations list and scrolling to Healthy Indiana Plan 2.0.
There is no timeline for a federal response to the state's HIP 2.0 application, which was certified complete Aug. 22.
Pence has said he's hoping for prompt approval so HIP 2.0 enrollment can begin early next year.
Under HIP 2.0, an estimated 450,000 able-bodied Hoosiers ages 19 to 64 who earn less than 138 percent of the federal poverty level — that's $16,105 for an individual or $32,913 for a family of four — will be eligible for the HIP Plus plan.
Those participants, who otherwise would have been able to enroll in no-cost Medicaid, instead will be required to contribute between $3 and $25 a month, based on their incomes, to a health savings account the program will bring up to $2,500.
A member's annual health care costs, including vision, dental and prescription drug services, initially would be paid from that account, with the program covering all expenses beyond $2,500.
But if an enrollee fails to make their health savings account contribution, he or she will be dropped to HIP Basic, which offers reduced benefits and requires co-payments for all services. Depending on income, some delinquent participants will lose their HIP coverage altogether.
A third tier of the program, HIP Link, allows HIP-eligible working Hoosiers to use their health savings accounts to pay their share of costs associated with an employer-provided health plan.
The majority of health care costs for HIP 2.0 participants would be paid by the federal government, using Medicaid expansion funds from the Affordable Care Act, also known as Obamacare.