Indiana Gov. Mike Pence spent over 10 years in the House and had established conservative credentials with many of his policy stances on immigration and family values. The former Tea Party Caucus member now has some conservatives mad over his health care plan for his state that could bring health care to over 450,000 low income uninsured residents. He plans to expand the state’s Healthy Indiana Plan which now covers about 50,000 low income residents. The plan would rely on health care savings plans and patient input according to the governor’s office but what gets conservatives mad is the fact that it will rely on over $16 billion of federal money to pay for its $18 billion cost. Indiana will shell out $1.5 billion. So the question becomes – aside from the balancing act Pence has to play between calling for an end to Obamacare and expanding health care coverage in his own state – do subsidized health savings account promote more efficient use of health care services?

The answer would depend on how Indiana plans to use these so-called health care savings accounts. The essence of a true health savings account is you control how much you save and how much you plan to use now or to set aside for future costs. What strings would be attached in Pence’s plan? When the federal government is contributing about 90& of the costs you can be sure that conditions will be rapidly attached and a whole slew of rules for the benefit of the low income earner will be put into place. Would the governor consider using the health care plans as a way to fund the costs over time – perhaps giving an increasing amount of room for the plans after a certain amount of time – rather than use them as a way to control costs? Or could both approaches work side by side? The answers will tell if Indiana’s plan is an alternative to, or just an extension of, Obamacare.