Big Bills Boosting Mental, Public Health Advance

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

April 18, 2023

Indiana’s lawmakers on Monday stayed well into the evening to approve multiple priority health bills as they sought to meet critical deadlines: in the House, a deadline for final passage, and in the Senate, for chamber-wide amendments.

Legislators sought to bolster mental health and public health infrastructure while chipping away at the state’s persistently high health care costs.

They also moved proposals mandating public revenue sharing between traditional and charter public schools, and ditching “best available” floodplain maps for construction.

House passes big health bills

House lawmakers overwhelmingly passed major mental and public health legislation, alongside a bill banning certain restrictive provisions in doctor-employer contracts. The Senate priority proposals have racked up hours of hearings and floor discussion.

The chamber voted for the sweeping Senate Bill 1, which aims to fortify the relatively new 988 crisis response center and hotline with funding for mental health emergencies. It hinges on three concepts: someone for Hoosiers to call, someone to respond and somewhere for Hoosiers to go.

“These past three years exposed what was already failing, which is a non-integrated behavioral health system in Indiana, a siloed system of care that was established in 1963 by President Kennedy,” the bill’s House sponsor Rep. Ann Vermilion said Monday. “It was built for a world that no longer exists.”

The bill passed on a vote of 96-3. Republican Reps. Chris Jeter of Fishers, Alan Morrison of Brazil and Zach Payne of Georgetown voted in opposition.

Lawmakers previously heard emotional testimony on that proposal — and got emotional themselves.

The chamber also pushed a massive restructuring of the public health system.

Senate Bill 4 would allow counties to access additional funds in exchange for providing enhanced services. They could also opt out. It’s the Legislature’s response to a system that has long delivered bottom-of-the-barrel public health metrics.

“[The pandemic] only brought to light the fact that this was uncoordinated, poorly funded — and this was our opportunity to make a difference,” the bill’s House sponsor Rep. Brad Barrett said. “The options: turn a blind eye and to continue to neglect this huge feature of what we offer our Hoosier citizens. The other option: create a system with the appropriate guardrails, maintain local control, incorporate grants and accountability.”

The bill comes out of a yearlong governor’s commission that found Indiana ranks 48th in the nation for per-capita public health funding — and came with a proposed $243 million annual price tag to close the gap. Lawmakers have slashed that total repeatedly.

House lawmakers previously passed a raft of changes, adding vaccine disclaimers, creating a task force to review pandemic-era legal authority and more. Attempts to fund it with a cigarette tax increase failed because of internal rules — but could hold in conference committee.

Gov. Eric Holcomb isn’t a fan of the pandemic language, telling the Capital Chronicle “In terms of public health, I don’t want to look back. We’ve litigated before. It was unanimously ruled in our favor, each and every case that came our way and so I think most Hoosiers are looking forward and that’s where I want to keep our eye — on the horizon not over our shoulders.”

The bill passed on a vote of 78-21.

Lawmakers also O.K.’ed Senate Bill 7, which limits the non-compete agreements doctors sign with their employers. The agreements bar those who leave their jobs from working in similar positions within certain timeframes and often-expansive geographical ranges.

All three bills have had edits during their stints in the House, so they’ll go back to the Senate for approval before going to Gov. Eric Holcomb. If the chambers disagree, they’ll conference and find compromises.

Health moves in Senate too, but with changes

Senators voted on Monday to amend a bill that had died in the House into a House priority bill, likely sending the bill to a conference committee as well.

House Bill 1004 initially penalized hospitals for costs exceeding 260% of Medicare, though that portion is now delayed until 2026. It also contained credits for Health Reimbursement Arrangements and physician-owned practices alongside a health care costs oversight board.

Senate Bill 6, meanwhile, would’ve barred hospitals from charging insurers inpatient prices for outpatient services – though hospitals and insurers disagreed on that premise. It died in a House health committee without a hearing.

But on second reading on House Bill 1004, when the full chamber votes to amend a bill, senators inserted some of that language back in – exempting behavioral health services and oncology. It also now requires hospitals to submit certain financial data as well as going rates for services across insurance types, including self-pay, employer-sponsored and government health coverage.

Unless the House concurs with the change, the bill will head to a conference committee where the two chambers will work out the differences.

Charter schools want in on public funding

Lawmakers in the House additionally approved Senate Bill 391, which currently seeks to force school districts in specific areas to share referendum funding with public charter schools. It passed out of the chamber, but with bipartisan opposition, 64-33.

The proposal requires school districts in Lake, Marion, St. Joseph and Vanderburgh counties — where a majority of the state’s charter schools are located — to provide a proportional share of an operating or school safety referendum adopted after June 30 with area charters. In other counties, sharing those funds would remain optional, at least for now.

“This is an effort to create some type of parity between these two public schools,” said Rep. Bob Behning, R-Indianapolis, on Monday.

Traditional school officials have argued that charters are not entitled to funding from local property taxpayers because those schools generally do not have the same expenses as their traditional public counterparts.

“This bill is — in my mind — a critical breach of covenant between this body and the people of this state … when the legislature said that the state would take over a more substantial role in funding our public schools,” said Rep. Ed DeLaney, D-Indianapolis. “We’re backing up, and we’re changing that. We’re putting a strain on our property tax and on our traditional schools.”

But advocates for charters have ramped up lobbying during the legislative session in an effort to “equalize” funding for the alternative public schools and ensure that students in charters receive the same amount of dollars as students who attend district schools.

Although an earlier version of the legislation would have sunset Indiana’s existing “$1 Law,” which requires public school districts to sell or lease vacant or unused instructional buildings for a single dollar to charters, that language now just applies to counties where referendum dollars are being shared.

No best data, for now

House lawmakers on Monday approved a bill that would repeal a requirement for local administrators to use the latest statewide floodplain maps when deciding new construction projects.

Authored by Sen. Jean Leising, R-Oldenburg, Senate Bill 242 seeks to nix a provision in current state law that requires floodplain administrators to use the “best floodplain mapping data available” when reviewing an application for a construction permit in or near a floodplain. In the bill’s latest version, that would apply for two years.

That means outdated federal floodplain maps would be temporarily used by administrators, rather than the new, more comprehensive maps adopted by the Indiana Department of Natural Resources (DNR).

Bill sponsor Rep. Brad Barrett, R-Richmond, said the measure “empowers landowners” while keeping the state floodplain maps “intact as provisional maps.” He also emphasized that property owners can still use the FEMA maps, if they choose.

Democrats, however, were largely opposed.

“We know that the DNR maps are highly accurate. We know that FEMA supports using them. And we know that water always wins,” said Rep. Carey Hamilton, D-Indianapolis. “We know that with this bill, the legislature is saying, ‘Let’s pretend these maps, which were created to protect our communities … Let’s pretend they don’t exist.’ This bill is irresponsible and will increase risk floods to our communities.”

The bill passed on a 73-25 vote and now heads back to the Senate for final approval.

The Indiana Capital Chronicle is an independent, nonprofit news organization dedicated to giving Hoosiers a comprehensive look inside state government, policy and elections. The site combines daily coverage with in-depth scrutiny, political awareness and insightful commentary.