Recent editorials published in Indiana newspapers

South Bend Tribune. Dec. 5, 2019

The good and bad news about health care in Indiana

Indiana's plan to seek a 10-year extension for the Healthy Indiana Plan is good news for the hundreds of thousands of low-income Hoosiers who joined the ranks of the insured thanks to the program.

The bad news? At the same time, the state, led by Attorney General Curtis Hill, is backing a lawsuit that could eliminate all funding for that program.

So goes the confounding reality in Indiana, a state facing a mountain of health challenges: In the most recent America's Health Rankings, it ranks 41st in overall health, with some of its lowest rankings including obesity (39th place) and smoking (44th).

HIP, an alternative to the Medicaid expansion provided for by the Affordable Care Act, has helped the state make inroads in reducing the number of uninsured Hoosiers since it was approved by the federal government in 2015. In the first year of Medicaid expansion, the number of uninsured declined 19 percent; in the second year of expansion, the number of uninsured dropped another 16 percent.

Last month, the Indiana Family and Social Services Administration posted notice of its intent to request a 10-year extension of the federal Medicaid waiver that established the current HIP program, which would expire on Dec. 31, 2020. Its request includes a proposal to extend the expanded substance abuse and serious mental illness components of HIP through 2025.

But all of that could be for naught, depending on the decision by the 5th Circuit Court of Appeals. That decision could eliminate nearly all federal funding for HIP if it strikes down the Affordable Care Act in its entirety. That's what a coalition of attorneys general of about 20 states - including Indiana's Hill - is asking the court to do. Any decision by the court will likely be appealed to the Supreme Court.

All of the attorneys general who signed onto the challenge are Republican. Nine, including Indiana, represent states that took the federal money made available by the ACA to expand Medicaid eligibility.

Hill has said that regardless of any good it does, the ACA is federal government overreach.

Last year, a health care coalition of eight advocacy groups called on the attorney general to withdraw Indiana from the lawsuit. A spokeswoman for the group said the ACA has 'œhelped millions of Hoosiers access care and live healthier lives.'ť

That's now at risk - and 600,000-plus Hoosiers have reason to fear they'll lose their insurance. All because of a politically motivated exercise that goes against the interests of millions of Americans - and offers no alternative for those who stand to lose their health coverage. Hill never should have aligned Indiana with this reckless lawsuit.

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The (Fort Wayne) Journal Gazette. Dec. 6, 2019

Healthy effort

Legislative leaders are always reluctant to make promises for a short session of the Indiana General Assembly. That's true for the upcoming term, which House Speaker Brian Bosma said Wednesday will wrap up by March 11 '“ before the NCAA men's basketball Midwest regional tips off in Indianapolis.

But basketball fans won't take precedence over efforts to address the state's high health care costs. In remarks at the annual Legislative Conference Wednesday, Senate President Pro Tem Rodric Bray, R-Martinsville, insisted the issue is a priority for his caucus.

'œThere are two major reasons to be concerned about that: First and foremost is the cost of health care for Hoosier families,'ť Bray said. 'œWhen somebody is trying to pay the premium for their health care for their family and by the time you get your premium paid throughout the year, the deductible paid, you're probably $20,000 or $30,000 on health care before insurance has helped you at all '“ and that becomes unsustainable for many, many families.'ť

Bray said that for Hoosiers 'œwho are fortunate enough to have health insurance coverage through their employers,'ť the cost represents a large portion of their salary because of the cost carried by the employer.

'œIt really becomes an economic development piece, as well,'ť he said. 'œWe pride ourselves here in the state of Indiana to have a good tax structure that is competitive; to have a strong regulatory environment that gets the job done '“ makes sure certain interests are protected without being overly bureaucratic. And this piece is part of that competitive edge, as well.'ť

Bray, an attorney, said Indiana is an outlier among states for its health care costs. He cited a Rand Corp. study released earlier this year that compared prices private health insurance plans paid to almost 1,600 hospitals in 25 states from 2015 to 2017. The charges in Indiana were the highest among those studied.

'œThat puts us at a competitive disadvantage,'ť he said. 'œSo you're going to see us looking deeply at that.'ť

Sen. Ed Charbonneau, chair of the Senate Health and Provider Services Committee, has been working for months on the issue, according to the Senate leader.

Bray said transparency in billing will be a focus of the legislation, along with surprise billing '“ where patients discover after treatment that a provider was not in their insurance company's network of approved providers. Legislators also are looking at barriers to entry in the health system that might discourage competition and increase costs.

House Minority Leader PhilGiaQuinta, D-Fort Wayne, said his caucus supports the effort.

'œThere seems to be some momentum for doing some things on the health care front,'ť he said, 'œwhether it's prescription costs, more transparency with billing. We would certainly support that.'ť

GiaQuinta said he would also like to see the legislature address other health care concerns beyond cost.

'œWe have a real problem with regard to infant mortality. That's a health issue, too,'ť he said. 'œIf there's an increase in the cigarette tax, (new revenue) should go into programs to help in those areas with the most need. We know the ZIP codes with the highest rates; we know where the people who need help are. One of those ZIP code areas is in my own district.'ť

Work done this year in interim study committees will guide the legislation, according to the Senate leader.

'œWe look forward to a short session where we're not going to fix all of this, I assure you '“ it's much too complex for that, but really begin to move the state forward in that regard,'ť Bray said.

Whatever can be done in the upcoming session to lighten Hoosiers' health care cost burden will be much appreciated.

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Kokomo Tribune. Dec. 6, 2019

Sex ed lacking

A national analysis of sexual violence by the Centers for Disease Control found 15% of high school-age females in Indiana reported having forced sexual intercourse in 2009.

It was the second-highest percentage in the nation and 3 percentage points higher than the rest of the country.

Nine years later, The Herald-Tribune of Batesville reported the percentage of Hoosier girls who had been raped was even higher.

'œIn a survey done by the Centers for Disease Control and Prevention, Indiana is No. 1 in the United States for the most rapes involving teen girls,'ť Catherine Dwyer, the rape crisis support and advocacy series program manager at Lawrenceburg's Community Mental Health Center, announced at an April 2018 Take Back the Night event.

The percentage of Hoosier girls in grades 9-12 who reported being forced into sexual intercourse was 17.3%, Dwyer told the Lawrenceburg crowd. The national average is 10.5%.

And experts say the sad fact is the actual number might be even higher because up to half of sexual assaults never get reported.

The Indiana University researchers who analyzed the 2009 findings said the available data don't explain why Indiana ranks so poorly. They say the state's best approach, though, is to raise awareness of the issue.

The researchers recommend schools create more effective and age-appropriate programs and improve training of school staff. They also call for better ways to track, create and fund community-wide sex education programs.

None of these steps will come without cost, but surely our children are worth the expense.

A CNHI News Indiana report we published this past September found 31.7% of Hoosier high-schoolers said they were sexually active in a 2015 statewide survey. Yet in Indiana, sex education isn't required in schools.

The CDC says attackers in most cases are not strangers hiding in the bushes. Among female rape victims in 2012, perpetrators were reported to be intimate partners (51.1%), family members (12.5%), acquaintances (40.8%) and strangers (13.8%).

The national Sexual Violence Resource Center in Pennsylvania says 1 in 5 women will be a victim of sexual assault by the time she finishes college. The best way to lower that number, the center says, is by raising awareness and by holding the perpetrators responsible for their actions.

Sexual assault isn't an easy subject to discuss. Most of us just aren't comfortable bringing it up.

But this statistic should be enough to spur all of us to action and move the Legislature to require sex education in schools: According to the CDC report, nearly 1 in 6 Hoosier girls in high school reported being raped.

That's a number we simply can't tolerate.

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