The 2021 Indiana legislative session was unusual due to the pandemic. The contracted number of bills actively considered focused on COVID-19-related issues, state budget creation and the most concerning issues to legislators. This selected review of health-related legislation comes through the lens of a family physician and former public-health official.
The session was notable for what was not considered or did not survive the session; many bills were simply put off until next year. Scope-of-practice proposals, including signature authority expansion for nurse practitioners (APRNs); more practice freedom and prescriptive authority for physician assistants; and a proposal, supported by the medical community, granting authority to pharmacists to prescribe birth control pills were unsuccessful.
Regrettably, once again, the Legislature failed to increase the cigarette tax or prohibit flavorings in vaping products. No legalization or decriminalization proposals for marijuana were heard.
Also not considered this session was a measure to add clarity to the identification and advertising of health professionals, including designations reserved for physicians. Many patients are confused about who exactly is providing their medical care.
There were many good outcomes: A bill that would have prohibited workplace immunization requirements died—reason prevailed. The budget included increased funding for mental-health programs and the expansion of residency positions to principally address Indiana’s lack of primary-care physicians. Grant funding for family-medicine residencies and Marian University College of Osteopathic Medicine tuition scholarships to promote primary-care careers was maintained. Continued funding was provided for two excellent public-health programs to address optimal pregnancy outcomes. Also, legislation was enacted allowing individuals to execute a single document for all aspects of health care advanced directives.
Also greatly welcomed was legislation that establishes a $40 million state-supported grant program for community-based health initiatives, especially for chronic diseases. Dentists were given limited immunization authority (similar to pharmacists). We need all the help we can get to maximize vaccination rates.
The Legislature did pass a tax on vaping liquids and devices at an amount to reach taxation parity with cigarettes. Syringe-exchange programs were extended to 2026, vital for preventing spread of drug-use-related HIV and hepatitis C. Outstanding public-health measures.
Expansion of accepted communication modalities and providers for telehealth was another positive result. We learned the value of incorporating telehealth during the COVID-19 crisis, but I caution that patients should not receive all their care electronically.
Prohibition of using telehealth for medically induced abortions was predictable, but the requirement that providers inform patients of an unproven medication use for reversal of medical abortions in progress was outrageous.
Parent education regarding cardiac conditions in student athletes that could lead to sudden cardiac arrest and parent sign-off for return to play after a concerning incident was enacted. This is much-needed legislation.
Two COVID-19 liability protection bills passed, giving health care providers immunity for COVID-19 premises exposure and good-faith but unavoidable shortfalls in certain aspects of COVID and non-COVID medical care during the emergency declaration. Health care professionals who stepped up during the crisis deserve these protections.
Most disappointing were Senate Bill 5 and House Bill 1123, which essentially give ultimate approval and oversight over emergency executive orders issued by the governor and county health officials to the Legislature or local governing bodies, respectively. These potentially more political decisions might restrict the ability of the governor and local health officials to act adequately and decisively during declared disaster emergencies. The governor’s veto, likely to be overridden, blocks SB 5.
Shortsighted political pushback that tainted an overall positive legislative session.•
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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 ibjedit@ibj.com.
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