From the beginning of my tenure as governor in 2013, we have been saying no to ObamaCare in Indiana. We refused to set up a state-based exchange, and we have said we will not expand traditional Medicaid. We have a better alternative in a program that offers Indiana's working poor the chance to get insurance and control their own health care.

Medicaid is not a program we need to expand. It is a program we need to change. Nobly created 50 years ago to help the poor and those with disabilities get quality health care, Medicaid has morphed into a bureaucratic and fiscal monstrosity that does less to help low-income people than its advocates claim. As a study in Oregon showed last year, the 2008 expansion of Medicaid to 10,000 more people increased emergency-room use and produced health outcomes that were no better than for those who remained uninsured. Other studies have shown similar results.

Yet there are still some 350,000 low-income working people in Indiana who lack access to the quality health insurance that better-off Hoosiers enjoy. We want to change Medicaid based on what we know improves health and lowers costs. So six years ago Indiana became the first state to successfully create a consumer-driven health plan to expand coverage to members of this uninsured population.

The Healthy Indiana Plan (HIP) now provides health-savings accounts, or HSAs, to nearly 40,000 people and empowers them as health-care consumers. According to a Milliman analysis of HIP and traditional Medicaid claims, 7% fewer HIP members used the emergency room in 2012 compared to traditional Medicaid enrollees.

Another Milliman study showed that 60% of HIP enrollees in 2012 obtained preventive-care services such as annual physicals and flu shots—a rate similar to that of the general commercial marketplace. HIP enrollees choose generic drugs at a much higher rate than people covered by other private insurance plans. A five-year Employee Benefit Research Institute study published in 2013 showed that consumer-driven health plans can decrease health-care spending by 25%, and we are beginning to see this downward trend in health-care costs with HIP.