Indiana’s top lawmakers on Monday indicated that Republican Gov. Eric Holcomb’s Public Health recommendations — including additional health care spending of $243 million annually — will face a tough crowd in the General Assembly.
They spoke at an Indiana Chamber of Commerce legislative preview, ahead of a January session that will include crafting the state’s next two-year budget.
“I found a little bit difficult to swallow,” said GOP Senate President Pro Tempore Rodric Bray (R-Martinsville) of the hefty price tag. He added that local health departments might not even be able to handle so much money all at once even if lawmakers were to authorize it.
Senate President Pro Tempore Rodric Bray, R-Martinsville. (Senate Republican website)
“I think it might be difficult,” to fund the total $480 million request in the budget, Bray said. Instead, that number is “a good place to work toward” and that Indiana would focus on the infrastructure to implement those changes in the meantime.
But he also expressed doubt that the extensive recommendations would help lower health care costs, which he said is a priority.
House Speaker Todd Huston, R-Fishers, said Indiana already invests in public health — though “it may not be as much as people like” — and that if Indiana adds more money, it should “support actionable goals with measurable outcomes.”
Indiana ranks 48th in the nation for public health funding, spending approximately $55 per Hoosier on public health initiatives or $36 less than the nationwide average of $91 per capita.
Huston said he’d asked Public Health Committee Chair Rep. Brad Barrett, R-Richmond, and Ways and Means Committee Chair Rep. Jeffrey Thompson, R-Lizton, to do a “deep dive” of the 107-page report — though he made no promises on the results of those analyses.
“Some [recommendations], not all, will be successful — or certainly entertained,” Huston added.
Taking it seriously
The General Assembly’s top Democrats pushed back.
“We have a lot of problems here, when it comes to health care in this state, and health care costs is obviously one of those,” said House Minority Leader Phil GiaQuinta, D-Fort Wayne. “… I think it signals that we aren’t taking the issue seriously if we don’t really adhere to the recommendations.”
Senate Minority Leader Greg Taylor, D-Indianapolis, pounced when Huston said that, “first and foremost,” Hoosiers can improve health care outcomes by taking personal responsibility.
“I think that’s the problem that we’ve seen over the last 20 years of the leadership in the state of Indiana,” Taylor said, referring to GOP rule. “Access to health care is the first step.”
Government, Taylor said, is heavily involved in the development and approval of new medications and shouldn’t bow out on pricing.
The report’s architects — State Health Commissioner Dr. Kris Box and Luke Kenley, a former chair of the state Senate’s Appropriations Committee — said they hoped their work would be translated into legislation at an unveiling in August.
“We need to be able to overcome the skepticism,” said Sen. Ed Charbonneau, R-Valparaiso, and chair of the Senate Health and Provider Services Committee, at the time.
Getting down to the (health) specifics
Though the four legislative leaders also spoke on the budget, education and more at Monday’s hourlong Q&A, they spent much of the time health care and affordability. The lawmakers floated several specific solutions, but cast doubt on others.
— Cigarette tax: The chamber has long backed an increase in Indiana’s cigarette tax to dissuade smoking — tobacco use and its negative health impacts costs Hoosier employers $6 billion annually, according to the organization. It’s gunning for a $2 bump, or at least $1.
Huston’s chamber has passed such legislation before, but it didn’t get past the Senate — and he didn’t expect that to change, calling an increase “unlikely to highly unlikely.”
Bray said his caucus would try to boost Indiana’s health care metrics and restructure public funding based on Holcomb’s commission, but was noncommittal on changes to the cigarette tax.
— Nurse practitioners: The chamber outlined just one health care-related legislative priority in a news release Monday: to address provider shortages by broadening scope-of-practice laws for “low-level” providers like nurse practitioners — and possibly mid-level ones.
Huston said the solution was too narrow a fit for such a broad access problem, and added that he wanted more independent primary care physicians rather than hospital-affiliated ones.
Bray also expressed skepticism.
“You’ll need to show me, to convince me that, one, that it really is less expensive, not more expensive” to have nurse practitioners take on some of the same duties as doctors, Bray said. He also wants to examine data from other states that have tried similar changes to ensure that nurse practitioners there have moved into rural parts of the state that lack in doctors.
— Abortion and more: After the event, Huston told reporters that his caucus would “stand pat” on abortion, rather than attempt more restrictive takes on Indiana’s near-total abortion ban. And he said there could be movement toward wider access to contraceptives.
— Mental health: Huston suggested increasing the reimbursement rate for mental health services to address the shortage of professionals.