Republican Gov. Mike Pence, who took office Monday, has ruled out a state-run health insurance exchange in Indiana, arguing its estimated $50 million cost wouldn't be worth the limited autonomy the state would gain.
Democrats maintain a state-run exchange would better serve residents, and Sen. Karen Tallian, D-Portage, said that she has filed a bill to put one in place.
"We need to get on board with setting up this exchange," Tallian said. "We need local control and participation in this is inevitable. ... There's no reason why, just off the top, we should ignore the possibility of doing an Indiana-controlled exchange."
Republicans dominate both the Indiana House and Senate and several of them have previously attacked the Affordable Care Act backed by President Barack Obama as burdensome and unconstitutional.
The decision by Pence, who opposed the overhaul while he was in Congress, likely means the federal government alone will design the online marketplace that Indiana residents will use to choose among health insurance policies when coverage begins in 2014.
Last year's U.S. Supreme Court decision upholding the health care law makes the overhaul impossible for the states to ignore, and Indiana officials should talk more about how to develop a state-run exchange that will work best for Indiana residents, said Rep. Ed DeLaney, D-Indianapolis.
"I'm paying taxes to fund this program on a national basis, so I'm going to pay for the guy in Illinois and guy in Michigan to have this health care, but I'm not going to give it to my fellow Hoosiers," DeLaney said.
Republican House Ways and Means Committee Chairman Tim Brown said he believed the state should be cautious before taking the step of in starting its own exchange.
"There's going to be a lot of inefficiencies in the beginning," Brown said. "States that are going to go to a state-only exchange, I think, are going to have a lot of growing pains. So hopefully Indiana can learn and make a decision at a later date whether it is worthwhile."
Tallian's bill also calls for an eligibility expansion for the state's Medicaid program by raising the income limits for a family of four to $33,000. She said the state's current Medicaid cutoff for such families is $4,100 a year and that the change would provide health care coverage to as many as 400,000 people, with federal funding covering most of the cost.
Brown said he was leery of eligibility expansion when the cost of the state's current Medicaid program was projected to grow by between 11 percent and 17 percent over the next two years.