Mike Rinebold, director of government relations for the Indiana State Medical Association, discussed the national health reform effort of 2009 as well as the 2010 sessions of the Indiana Legislature that began Jan. 5.

IBJ: From the view of the physicians you represent, what’s the biggest win and what’s the biggest disappointment to come out of the health care reform bills passed in the Senate at year’s end?

A: Pretty much, there is no winner. No one group walked away with everything they were asking for. There have been some positives that I think you could point to: providing access to insurance for everyone. Now, how that’s going to be paid for is obviously still a question mark.

IBJ: There’s a shortage of primary-care physicians in Indiana that’s predicted to only get worse in future years. What’s the most important thing the state could do to alleviate this problem?

A: With the cuts in Medicare combined with the lack of a fix to the sustainable growth formula (which calls for a 21-percent Medicare rate cut), it’s severely going to impact access. If you have Medicare rates drop, the fear is so will private insurance. As you roll that out, it becomes more and more difficult for practices to keep their doors open when you have practice costs growing at double-digit rates. In Indiana, we want to acknowledge and thank the General Assembly for last year establishing the framework and the structure for a grant- and a loan-forgiveness program. It still needs to be funded, but that’s a step in the right direction.

IBJ: What are ISMA’s key issues for this coming legislative session?

A: We are asking the legislature to bar contract language [inserted by some health insurers] that would restrict [physicians] from having control of their patient panels. Also, allowing patients to direct their health insurer to pay their doctor directly, even if that doctor has no contract with the insurer. Physician shortage and recruitment—we want to build on the foundation laid last year. And anything that reduces administrative burden for physicians.

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