June 28--With a 5-4 vote on Thursday to uphold the Obamacare Law, the U.S. Supreme Court reignited an issue that has disputed since it was signed in March of 2010.

"The immediate implications for Indiana are a huge increase in health insurance rates, especially for young people, and the need to decide whether to try to construct a so-called 'exchange' or let the federal government do so," Gov. Mitch Daniels said in a statement released Thursday afternoon. "The Court's ruling that the federal government has the constitutional power to do what it has done must be respected. But many actions that are constitutional are still unwise. The now undisputed facts that this federal takeover of one-fifth of our economy will worsen deficits, increase the national debt, raise health care costs, and force Americans off insurance coverage they have chosen, still argues for repeal of a dangerously misguided law and it's replacement by major reforms based on individual freedom and consumerism."

According to Daniels, Indiana has several issues to consider in the upcoming months.

One is to decide if the state will operate a health insurance exchange, leave its operation to the federal government, or form a federal-state partnership. Though Daniels' term ends in early 2013, a decision must be made by Nov. 16. Operation of a state-based exchange could cost $50 million to $65 million in the first several years of operation, Daniels said.

"Indiana has taken steps to research the potential implications of health insurance exchanges, but absolutely no decision has been made to establish a state-based exchange," he said. "Before a decision can be made, the state needs more information about how a federally-based exchange will operate and be funded."

Premium rates for Indiana's individual insurance market are estimated to increase an average of 75 to 95 percent beginning in 2014, according to Daniels' statement. According to a report prepared for the state by the actuarial firm Milliman, young healthy males can expect to experience premium increases between 100 and 250 percent of their current rate; some women over 55 can expect a 100 percent increase in premium rates.

The statement also claims that a Medicaid expansion would put one in four Hoosiers, or about 500,000 new enrollees, in Medicaid at a cost of about $2 billion over 10 years. The future of the Healthy Indiana Plan (HIP) is uncertain until the U.S. Department of Health and Human Services (HHS) responds to the state's HIP waiver request. Any decision to expand Medicaid in 2014 is entirely the province of the next General Assembly and governor.

Local Republicans do not see the court's decision as quite so grim.

"I guess I had no real expectation on what the decision would be," said Mike O'Brien, Hendricks County Republican chairman. "My reaction to it wasn't extremely strong. The Republicans are upset about it from a policy standpoint. The Democrats are celebrating it from a policy standpoint."

O'Brien said the court's decision to uphold the law will likely make the Republicans' cause even stronger this year.

"I think that the conventional wisdom was that politically, Republicans would benefit if some part of it, especially the part dealing with individual mandate was tossed," O'Brien said. "I think the opposite of that is true. I think that the conventional wisdom is that the Supreme Court validated the law that a majority of Americans disagree with, but that because the Supreme Court validated it, that it helps Democrats. Nothing has really changed. There has been a lot of attention on the Supreme Court and a lot of attention on election day. I think Republicans are actually in a stronger position than if any of the law would have been tossed, from a political, election year standpoint."

He said Thursday's decision wouldn't alter the ambitions of the Republican Party.

"I think we're at a point today where we were yesterday, and for the last two years," O'Brien said. "We have a law that a majority of Americans disagree with. The Republicans are looking this election year to get elected and go and repeal it. That is the focus of our efforts for the next five weeks."

The Indiana Chamber of Commerce also has concerns about the legislation.

"Conventional wisdom and national polls showed many Americans favored repeal of the measure, so we are surprised by the court's decision," said Kevin Brinegar, president and CEO of the Indiana Chamber of Commerce. "Our concern is the impact the health care law -- now that it's going forward -- will have on Hoosier businesses and their workers. Mandating coverage for pre-existing conditions and extending coverage for dependent children to age 26 will cause increases in health care costs; there is no way around it."

Brian Bosma, Indiana Speaker of the House, said, "D.C. is completely out of touch with Hoosiers" and that "Most Americans, and an overwhelming majority of Hoosiers, do not support this overreaching, overwhelming federally mandated approach to the nation's healthcare challenges. To say that it will have a negative impact on Indiana small businesses, Hoosier families, and our state's currently exceptional fiscal position may qualify as the understatement of the year."

Hendricks County Democratic Party Chair Charlotte Martin had not returned messages from the Hendricks County Flyer as of press time and the Indiana Democrat Party had yet to release a formal statement.

ryan.palencer@flyergroup.com

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