By Whitney Downard, Casey Smith and Leslie Bonilla Muñiz
Indiana Capital Chronicle

INDIANAPOLIS — Indiana’s lawmakers are nearing the end of a grueling nearly four-month legislative session, but three of their biggest priorities—aside from the budget—remain unresolved.

Legislators promised to push care-boosting, cost-cutting health initiatives, expand “school choice” options, and fight high property tax bills with relief.

Plenty could change in the session’s final days, which include a flurry of conference committee meetings and even more bouts of closed-door discussions.

Where will healthcare bills end up?

Following the rosy forecast last week giving lawmakers an estimated $1.5 billion more in revenue, mental health is almost sure to get an increase from its previously allotted $35 million.

Senate Bill 1 would shore up the state’s mental health crisis system, primarily by funding 988—the counterpart to 911. But legislators still haven’t determined if the system, which is expected to cost $130.6 million annually, should be funded via overall tax dollars or a dedicated funding mechanism.

Federal law allows states to charge up to $1 each month on cellphone bills, which is the same amount Indiana now charges for 911 call centers. However, states have been reluctant to charge so much.

Sen. Mike Crider, the author of the bill, has previously indicated that he would prefer to see a stable form of funding, like cellphone fees, over a one-time infusion. Though the $1 dollar may seem steep, he said it was an important enough service to justify it.

However, the former law enforcement officer acknowledged that would be a difficult sell during a session in which the state has such a large projected surplus.

Leaders, however, remained resolute that public health funding wasn’t as likely to see major funding changes. They’ve settled on roughly $225 million over two years to boost the underfunded and beleaguered program.

“It’s a historic investment,” House Speaker Todd Huston said on Thursday, April 20. “That number—well, maybe not exactly that number—will be in the ballpark. …That was one place where there seemed to be pretty close proximity” between Republican caucuses.

Members of the General Assembly appeared torn over the legislation, questioning how much funding local public health departments needed. And several House amendments added language requiring vaccine disclosures and analyzing whether health departments overstepped their authority during the pandemic.

It’s unclear whether the Senate will agree to keep those changes. The bill is scheduled for a conference committee on Monday, April 24.

House Bill 1004 had a conference committee on Thursday but lawmakers acknowledged that there hadn’t yet been any final decisions. The bill initially penalized hospitals for exceeding 260% of Medicare costs, a move healthcare providers derided as arbitrary.

In a statement last week on the proposal, Indiana Hospital Association President Brian Tabor asked for more to be done on the insurance side of the equation.

“There must be equal accountability across the entire healthcare sector, or we will see harmful, unintended consequences,” Tabor said. “…We stand committed to finding the appropriate way to reduce healthcare costs in a sustainable manner, but there can be no long-term solution without raising low Medicaid payments and addressing how poorly insurance companies reimburse Hoosier doctors.”

Several legislators have acknowledged that Medicaid reimbursement rates are lagging, ordering the state to study the issue before the next session. On Friday, April 21, Tabor’s organization repeated its call to increase Medicaid reimbursement in the state’s two-year budget, saying it currently only covered 53% of the actual cost of care.

“Urban and rural safety net hospitals throughout Indiana are at their breaking point,” Tabor said Friday. “Rising expenses for labor, drugs, and medical supplies coupled with sicker patients, longer hospital stays, and low Medicaid reimbursement rates…have created an unprecedented financial strain on hospitals.”

Hospitals say they overcharge commercial payers to make up for losses under government insurance programs, one of several elements legislators would like to study before the next legislative session.

Senators seemed to acknowledge that one of their priority bills to limit how hospitals charge “site of service” fees wasn’t advancing through the House and amended part of that language into House Bill 1004. But another aiming to reduce prescription drug costs is scheduled for a conference committee on Monday.

Senate Bill 8 would require pharmacy benefit managers to pass on a significant amount of their cost savings onto consumers or payers, but has confusion mounted over what impact that measure would have.

The Indiana Capital Chronicle is an independent, nonprofit news organization dedicated to giving Hoosiers a comprehensive look inside state government, policy and elections.

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