Health Care Costs Among Indiana’s Top Legislative Priorities – Indianapolis Business Journal

State legislators and businesses alike have long decried Indiana’s high healthcare prices, but they haven’t yet sanctioned any players in the industry. Advocates are hoping for more in the 2023 hearing, which is set to begin Monday, with a heavy focus on the state’s hospitals.

Hoosiers have some of the highest costs in the country despite having a generally low cost of living and below average salaries. The latest report from Rand Corp., a nonprofit public policy research organization, found that hospital rates in Hoosier State are the seventh highest in the country, down slightly from previous years.

“(Hospitals) do everything they can to prevent competition but then want to have the freedom to price (services) any way they want,” said Al Hubbard, president of Hoosiers Affordable Healthcare. “If you don’t have competition, you take advantage of the situation and that’s what hospitals do.”

Hospitals are committed to doing their part to lower prices, said Brian Tabor, president of the Indiana Hospital Association, saying that prices will come down over time because of the new transparency initiatives.

“We are confident we are heading in the right direction, but we are also at a time when hospitals across the state are facing tremendous financial pressure, and the wrong policies can have devastating effects,” Tabor said. “There is no doubt that we still need to address affordability at Hoosiers, and hospitals are doing our part. But until all sectors of healthcare are brought to the table and there is equal transparency, we will not make long-term progress.”

Lawmakers passed a bill in 2020 to create a claims database, and create a hospital price transparency tool in the hopes that Hoosiers can shop around for the best rates. But the needle hasn’t moved enough to make savings.

“People don’t shop for rates after deductibles are met because they see it as free (through their insurance). When people are dealing with a fragile health situation, they’re not shopping; they’re doing what their doctor tells them to do,” Hubbard said.

Public health funding is at risk

Just before the 2022 session, House Speaker Todd Houston and Senate Pro Tim Roderick Bray sent letters to Health insurance companies And the healthcare systems He warned that if companies do not reduce their prices, the general assembly will.

Indiana University Health, the largest healthcare entity in the state, announced shortly after that it would freeze its rates through 2025, which has put some people off guard. denounced as a “gimmick” Since its costs far exceed national averages. Speaking on behalf of the state hospitals, prof Indiana Hospital Association He promised to reduce overall health care costs but rejected “harsh government intervention”.

But hospitals routinely note that Hoosiers have some of the worst health outcomes in the country, including higher rates of smoking, more diagnoses of diabetes and higher rates of maternal/infant mortality. Hospitals argue that these contribute to higher-than-average healthcare expenses in the state and need to be addressed.

Local health programs usually address these problems but have been ineffective due to poor public health funding in Indiana, which ranks 47th in the nation. The governor’s public health committee, of which Tabor was a member, reported that only the state of Indiana spent $45 per person in public health dollars compared to the national average of $91.

Tabor said hospitals need stabilization at this time, not more interventions, to recover after years of strain that overwhelmed the health care system during the COVID-19 pandemic.

“I hope this is a session about investing in health care, not making an already fragile system more vulnerable,” Tabor said. “Hospitals, and the entire healthcare system, have barely begun to rebuild after years of stress that have stretched our resources beyond imagination. We must ensure that hospitals and caregivers have the resources they need and reject policies that would destabilize the system in these uncertain times.”

But the Republican leaders who drafted the budget seemed skeptical that they could meet the committee’s recommended $243 million a year request, even though a third of Indiana’s counties spend $10 or less per resident on public health.

“I found it a little hard to swallow,” GOP Senate Leader Roderick Bray said in November, adding that local departments may not be able to handle so much money at one time.

In response, the backers modified their request, proposing that the state be in the phase of funding it during the two-year period and halving their request, to $120 million, for fiscal year 2024.

“We’ll have to debate that because it’s ongoing,” said Sen. Ryan Mishler, who leads the chamber’s budget process. “This is not a one-time deal, this is ongoing, so we have to take a hard look at that.”

But Micheler said the entire second-year funding of $243 million would be “tight”.

Hospitals are under more scrutiny

Sen. Travis Holdeman, R-Markle, says he has a way to pay for public health improvements: shifting the cost to hospitals.

Holdeman, chairman of the Senate Fiscal and Fiscal Policy Committee, has proposed a tax or assessment on hospitals and health insurance companies that do not adequately serve the community. He said the entities, which do not pay taxes, have transferred profits into investment accounts on Wall Street, accumulating so much in their accounts and reserves that many can work for more than a year without charging anyone.

“What are they doing to return the societal benefit they pledged to provide because of their nonprofit status?” Holdman said at the December conference. “I would like to give kudos to Parkview Hospital in Northeast Indiana. They are developing and building a grocery story in the Fort Wayne area that is a food desert.”

He said the effort—along with encouraging smoking cessation and reducing maternal and child mortality rates—would go further in benefiting the community than paying thousands of dollars to name a playground or local YMCA.

Hospitals have They have been targeted repeatedly By Ball State University economist Mike Hicks, who highlights the role of monopolies in rising healthcare costs in Indiana.

Market researchers corroborated some of Hicks’ criticism this summer, reporting that vertical integration and mergers drove up prices, Healthcare spending per capita increased by 48% between 2011 and 2020. That study found that Parkview Health, the same entity that Holdeman hailed, had a monopoly in the northeast corner of the state, leading to higher monthly premiums than the rest of the state.

Tabor pressed the monopolies discussion, pointing out that only two insurance companies controlled roughly 75% of the Indiana market. Indeed, some hospital mergers — which opponents said reduced competition — have stabilized weak healthcare entities.

“What’s ironic about the consolidation discussion is that most hospitals that become part of a health system wouldn’t survive on their own, so we need to be careful not to worsen access to care by weakening our Indiana providers,” Tabor said.

But Hubbard doesn’t seem to agree with Tabor, saying reduced competition is hurting Hoosier consumers.

“If these were for profits, we’d go after them. It all has to do with pricing them. And what we’ve found, what RAND (studies) have found, is that it’s the people who happen to be nonprofits who have the exorbitant prices,” Hubbard said.

Hubbard said every hospital nationwide has struggled with staffing in the wake of the COVID-19 pandemic, as overwhelmed health care has left the industry in droves. But Hoosier hospitals still command some of the highest prices in the country, even in a state with a below-average cost of living and earnings.

“The easy way to fix that is to pass a law that says you can’t charge more than the national average… That’s what we’ve done with workers’ comp and it worked. We used to be one of the most expensive states in the country, and now we’re in the middle of group.” “If we can’t get it done with incentives, we will go back and ask for a hard cap.”

Focuses outside hospital rates

Along with rising healthcare and public health costs, the 2023 session will also be the first regular session since the General Assembly passed a near-total summer abortion ban. While some conservatives argue the ban doesn’t go far enough — since the law allows exceptions for rape or incest — leaders probably won’t seek adjustments due to divisions in their caucuses.

But other topics may emerge from the abortion ban debate, including access to contraception and government support for families — both of which received boosted funding in a bill designed to accompany abortion bans.

Rep. Rita Fleming, D-Jeffersonville, has long worked to expand birth control prescriptions to pharmacies, which is a more convenient option for many Hoosiers — especially those in areas with a shortage of nurses or doctors.

“We know that most miscarriages occur among women who experience unwanted pregnancies. So if we really want to address the root problem — if we want to reduce abortions — it makes sense to reduce unwanted pregnancies,” Fleming said.

legislators The amendment was narrowly rejected Expanding access to contraceptives in the special session by a 48-49 vote that included support from many critical Republicans.

“I think there are people on both sides of the aisle who understand that increasing access to contraceptives…is a great idea. I truly believe that no matter who is carrying it, it will pass through the house.”

In addition to reproductive health care, Fleming said Indiana needs to increase the number of its providers, particularly in the area of ​​public health and mental health.

“We need to incentivize providers to work in Indiana and help solve these mental health issues,” Fleming said. “We need to help people understand that it can be a chronic process and you can’t just treat someone in one visit, it’s ongoing.”

In addition, the retired ob-gyn said she wants to reduce administrative burdens to free up doctors to spend more time with their patients, saying doctors average 15 hours each week to manage pre-authorizations or denials for necessary procedures.

the Indiana Capital Chronicle is an independent, not-for-profit news organization covering state government, politics and elections.

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