Dr. Richard Feldman: Reviewing health bills from this legislative session

This Indiana legislative session was relatively light in the number of health-related bills actively considered, yet several held significant importance. Concerns over a potential budget shortfall influenced the session. The session commenced under the shadow of a $1 billion underestimation of Medicaid costs. By the end of session, the overall budget deficit projection for the upcoming biennium reached $2.4 billion.

Let’s explore the health-related legislation from my perspective as a family physician:

The budget bill, House Bill 1001, includes a long-awaited increase in the cigarette tax of $2 per pack, nearly tripling the total tax. Taxes are also increased for other tobacco products, including vapes. These increases will amount to an additional $800 million in revenue over the biennium.

Alas, the motivation for these increases is purely economic, rather than for improving health. In fact, funding for Health First Indiana, aimed at supporting local health departments in addressing pressing health problems and public health infrastructure, is reduced from $150 million in 2024 to $40 million yearly. Additionally, there is a new requirement that none of this funding be used for tobacco prevention programs. Huh? Public health support continues to be inconsistent and inadequate.

Creating more residency slots is an ideal strategy to address Indiana’s great need for more physicians. To sustain the excellent progress in expanding residency training, primarily in primary care, $14 million yearly is needed, but funding remained stable at $7 million.

The Medicaid bill, Senate Bill 2, contains measures to reduce Medicaid cost and enrollment, including increased investigations of fraud, waste and abuse; Medicaid advertising restrictions; stringent quarterly database reviews of recipient eligibility; and increased scrutiny of hospital use of “presumptive eligibility” of patients (used to quickly facilitate coverage determinations and hospital reimbursement). Hospitals will face sanctions for repeated violations of standards.

Indiana’s Medicaid expansion, the Healthy Indiana Plan, reinstitutes work requirements for able-bodied individuals. The bill also allows, depending largely on potential federal cutbacks, for the state to alter, limit or terminate HIP. One way or another, bet on Medicaid rollbacks.

HB 1003: Among other new requirements, outpatient ancillary sites owned by hospitals cannot charge hospital rates.

Hospitals face considerable pressure to reduce pricing. Although disputed, a RAND study found that Indiana hospitals are among the most expensive in the country. HB 1004 involves studying nonprofit hospital pricing, particularly in the five largest hospital systems. An established benchmark will be determined, and in 2029, hospitals above this threshold will lose their nonprofit status. Wow.

HB 1555 allows certain foreign-residency-trained physicians with practice experience to bypass American residency training for licensure to practice in underserved areas. The medical community worked to improve the bill by suggesting testing and supervision requirements. This is concerning; nothing can replace American residency training.

SB 480 is another valiant attempt to establish meaningful constraints on insurance prior authorization for medical services. Modest progress was made. PA determinations on request of a physician provider must be made by a physician in the same specialty. Determinations must be rendered within certain time limitations.

SB 475 extends the prohibition against physician noncompete clauses in hospital contracts from solely primary care to all specialties to increase hospital competition and preserve patient access to physicians.

Several “scope of practice” bills aimed to bolster the independence, licensure or practice parameters of nonphysician providers. None made it to the finish line. One notable bill proposed to allow pharmacists to diagnosis and treat certain medical conditions. They are not trained to do so. Bad idea.

A year of wins and losses amid extreme budgetary pressures.•

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Feldman is a family physician, author, lecturer and former Indiana State Department of Health commissioner for Gov. Frank O’Bannon. Send comments to [email protected].

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