The Future of Health Care

The future of health care reform is unclear, but there is no doubt that federal changes to the Affordable Care Act (ACA) will have major implications on Indiana and could affect the future of HIP 2.0 coverage expansion and Medicaid reimbursement for hospitals. Now more than ever, we must be engaged in the political process.


Voice your concerns with proposed legislation in Congress that would repeal and replace the ACA. Ask lawmakers to help preserve coverage for hundreds of thousands of Hoosiers.


Nothing is as powerful as your experience. Tell lawmakers that hospitals are critical to the health of Indiana’s economy. Tell them what significant cuts to the Medicaid program could mean to your hospital and your community.


Refer to IHA messaging below and utilize these talking points in your conversations with lawmakers.

Maintaining Coverage

  • Despite the flaws in the ACA, more than 450,000 Hoosiers now have health coverage under the law. At a minimum, we ask that Congress protect those individuals by maintaining their pathways to coverage.
  • Whether the program is called a block grant, per capita caps or some other system, it must not leave states like Indiana with fewer resources to care for our must vulnerable populations.
  • It should be noted that if Medicaid funding is cut as part of reform, there are potential negative implications beyond the health care sector. Medicaid cuts are likely to reverberate throughout state budgets, impacting K-12 education, public safety and more.

Preserving HIP 2.0

  • With respect to the Healthy Indiana Plan (HIP) 2.0, we are concerned with provisions being considered in Congress that would reduce the federal funding for this vital program. This program is also supported by tobacco taxes and fees that all hospitals pay.
  • However, if federal matching funds to states for coverage expansions like HIP 2.0 are cut from today’s levels, the program would be phased out under triggers established in Indiana current law. This would mean hundreds of thousands throughout our state could become uninsured.
  • There has been bipartisan support for HIP since its inception a decade ago, and it demonstrates that states can successfully extend coverage in an innovative and fiscally responsible manner.
  • Giving states much-needed additional flexibility will allow new models like HIP to emerge that bend the long-term cost curve and improve outcomes.

Health Care Reform Principles

As Congress considers legislation to repeal and replace parts of the ACA, Indiana hospitals believe that:

  • To the extent possible, preserve delivery reform and pathways for population health efforts to continue.
  • We should strive to increase, not decrease, the number of Hoosiers who have meaningful health care coverage.
  • Further payment cuts are not sustainable and would have dire consequences.
  • We must continue to break down silos within health care.
  • We support aligning payment with incentives, but such methods should be monitored closely to ensure the desired result is achieved and equitable.
  • Reducing regulation and administrative burden is essential.
  • We should continue investing in the health care system of the future.
  • Hospitals should help develop replacement policies and be proactive in finding solutions.


Increased uncompensated care costs will burden hospitals, who are facing billions in funding cuts.

Hospitals lost billions of funding when the ACA passed and cut disproportionate share (DSH) payments, which hospitals received for caring for low-income and uninsured patients, and annual raises in Medicare reimbursement. Policymakers said the cuts would be offset by the reduction in the uninsured, which in turn would decrease the amount of uncompensated care hospitals provide.

The map above indicates the extent hospital providers have been impacted by existing Medicare provider payment cuts enacted by Congress to achieve Medicare payment policy and long-term deficit reduction goals over the next 10 years. The legislative cuts consist of ACA marketbasket cuts, Medicare DSH cuts and adjustments related to the three mandatory quality-based payment reforms: value-based purchasing, readmissions reduction program, and the hospital-acquired conditions program.

When the ACA passed, these cuts were offset by the increase of coverage included in the law. Indiana hospitals have worked to make up for these cuts by making sure Hoosiers have coverage. However, proposals to repeal the ACA without a robust replacement would likely result in coverage losses for thousands of Hoosiers. Any proposal should, at a minimum, maintain coverage levels or increase hospital funding to account for increases in uncompensated care costs.