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July 15, 2016

What Mike Pence, Trump's VP pick, has said about health care

Daily Briefing

    On Friday, presumptive Republican presidential nominee Donald Trump officially announced the selection of Indiana Gov. Mike Pence (R) as his running mate.

    Pence is the only person to have voted against the Affordable Care Act (ACA) in Congress and then implemented the law's Medicaid expansion as governor. Here's what else you should know about Donald Trump's vice presidential pick and health care.

    Pence in Congress

    Pence served in Congress for 12 years, starting in Jan. 2001.

    Early on in his tenure, he broke with his party on a major piece of health care legislation: In 2003, Pence was one of just 25 House Republicans to vote against creating Medicare Part D, the program's prescription drug benefit. The bill passed the House 220-215, with 204 of Pence's GOP colleagues voting in favor of the measure.

    Ryan Fisher, who served for several years as Pence's legislative director, told Indianapolis Monthly that Pence saw Medicare Part D as a new, unfunded entitlement that would add to the national debt. "There was never any, 'Well, maybe if we change this or that,'" Fisher said. "It was a principled stand."       

    Pence also stood out in Congress for sponsoring the first measure to defund Planned Parenthood in 2007: an amendment to an appropriations bill that would have blocked the provider from receiving Title X grants. Pence's amendment didn't pass the House that year, but a similar measure passed the chamber in 2011.

    Pence told reporter Sarah Kliff when the 2011 bill passed, "If Planned Parenthood wants to be involved in providing counseling services and HIV testing, they ought not be in the business of providing abortions." As governor, Pence has also signed several abortion restrictions into law, which could make the subject "a top-tier election issue" now that he's been selected as Trump's running mate, STAT News reports.

    Medicare, Medicaid, and the ACA

    While in Congress, Pence supported Rep. Paul Ryan's (R-Wis.) budget proposal—which would have turned Medicaid into a block-grant system and turned Medicare into a premium-support system—and opposed the ACA, which he called a "government takeover of health care."

    After becoming Indiana's governor in 2013, Pence continued to call for the ACA's repeal and refused to create a state-run insurance exchange, but he nonetheless implemented an alternative model of the law's Medicaid expansion.

    According to the Kaiser Family Foundation, under the Healthy Indiana Plan (HIP) 2.0, most beneficiaries with incomes below 100 percent of the federal poverty level (FPL) have the option of:

    • Obtaining basic health coverage; or
    • Making a monthly contribution of either $1 or 2 percent of their income—whichever is greater—to a health savings account in order to obtain more benefits, including dental and vision coverage.

    Beneficiaries with incomes between 100 and 138 percent of FPL are required to contribute about 2 percent of their income (a max of $27) a month to health savings accounts—and can be locked out of Medicaid for six months if they fail to pay premiums. All beneficiaries also face some cost-sharing requirements, including copayments of up to $25 for unnecessary ED use.

    In a 2014 speech, Pence told the American Enterprise Institute (AEI) that his "plan for state-based Medicaid reform is not only entirely consistent with the repeal of Obamacare, but ... helps make the case for why repeal is needed."

    Traditional Medicaid, he said, "is not only broke, it's broken," yet is expanded under the ACA. The program, he added, "has morphed into a bureaucratic and fiscal monstrosity that does less to help low-income people than its advocates claim."     

    By contrast, Pence touted HIP 2.0 as the "kind of market-based, consumer-driven approach [that] is essential to" improving health outcomes and "curbing the dramatic growth in Medicaid spending." He added, "I truly believe that once Obamacare is repealed," the plan "will serve as a model for what block-granted Medicaid programs could be in states across the country."

    Opponents of the expansion worry it harms low-income residents' access to care, particularly among those who may fall behind on their premiums, and questions remain about whether the alternative approach will save money, Kaiser Health News reports. The Pence administration and CMS are currently "brawling" over how to assess HIP 2.0, the Indianapolis Business Journal reports.

    Combating the opioid misuse epidemic

    As governor, Pence has led a state ravaged by the opioid misuse epidemic. He's advocated for a "three-legged stool approach" to combating drug misuse and addiction:  providing more treatment options, increasing prevention efforts, and strengthening law enforcement.

    "We can't just arrest our way out of this problem," Pence said at a National Governors Association meeting this year, adding that the opioid misuse epidemic is "really what keeps me up at night."      

    "There is no city, no town in the state of Indiana that is not affected by this stuff," he added.

    Pence has called for increased federal funding for drug treatment programs and increased federal cooperation with local and state law enforcement to identify and arrest drug dealers. He also has signed several related state bills into law, including measures to make the overdose-reversal drug naloxone more widely available.

    According to the Indianapolis Star, Indiana is one of four states where the drug overdose mortality rate has quadrupled since 1999. Last year, the crisis drew national attention when more than 180 people in the Scott County area contracted HIV as the result of sharing needles to inject prescription painkillers.

    Pence approved a needle exchange program for the area, explaining that he does "not support needle exchanges as anti-drug policy, but this is a public health emergency" (House roll call vote, 11/22/03; Fehrman, Indianapolis Monthly, 1/2/13; Business Insider/AOL News, 7/14; Kliff, Vox, 7/14; Nather, STAT News, 7/14; House roll call vote, 4/15/11; Pence, YouTube, 7/22/09; KFF, 2/3/15; Pence, AEI, 5/19/14; Galewitz, Kaiser Health News/Washington Post, 3/19; Russell, Indianapolis Business Journal, 7/9; Daudelin, Indiana Public Media, 3/21; Groppe, Indianapolis Star, 2/22; Gass, Politico, 3/26/15).

    How hospitals can help fight the opioid epidemic—and save millions in avoidable costs

    As legislators grapple with the opioid epidemic, hospitals are also rethinking their prescription practices. We polled over 200 acute care pharmacy leaders to understand how they are making formulary decisions, and what's the impact on reducing opioid prescriptions and related complications.

    Read the research brief to learn more about our analysis of more than 400 organizations to investigate the impact of multi-modal pain regimens, and how your organization may be able to save over $1 million by reducing opioid use during surgery.

    Download the brief

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