Extended Interview: Governor Frank O’Bannon
[Sorry, the video for this story has expired, but you can still read the transcript below. ]
SUSAN DENTZER: Governor, welcome.
GOVERNOR O’BANNON: Thank you.
SUSAN DENTZER: This state, for the last several years, has had a rate of uninsurance of 13.6 percent, which of course puts it nowhere near the high of uninsurance in the nation, nowhere even near the national average, which is about 18 percent. But, nonetheless, it’s, it’s high enough that any reasonable person would be concerned about that. When you took office, where did that issue sit in your list of things that you wanted to accomplish? How concerned were you about the rate of uninsurance?
GOVERNOR O’BANNON: I think all of us are really concerned with anyone who doesn’t have insurance. Everyone should have insurance. That gets into the fiscal management and how well you can move towards that goal, but, certainly, it’s a concern that we al have because if they’re not insured, they come to us in some form to, to help them out, whether it’s early and they need help, or it’s later when they’ve got problems that would cost a lot more to fix as physical problems or mental problem. So it’s a–it’s a basic concern, the health of the community, really, for, for–foresees the community as a whole being successfully.
SUSAN DENTZER: Now in 1997, the Federal Government of course passed the Children’s Health Insurance Program. You appointed a commission to look into how that program should be adopted here at the local level. What were your expectations of the commission when you appointed it to look into–
GOVERNOR O’BANNON: Well, it was to get a program up and running, very quickly, and make it simple and easy to, to be a platform, be included in, and then trying to find out exactly how we put it together, whether we use it through a program of Medicaid or whether we come up with a new program of our own, and just have the best we could serve the people and get the message out, and get the chik–children insured, and I think it’s worked very well.
We went through that process. I think we started out thinking about a program by itself, and have come back through the Medicaid program, that we’ve turned into an insurance program with members. They pay–they pay a small premium. They get services, and certainly make it a program that they can be proud to be a part of.
SUSAN DENTZER: When the state did finally adopt the plan that you just described, you gave some of your lieutenants marching orders. What were they?
GOVERNOR O’BANNON: Well, they were to–we were looking at 36,000 kids over the poverty level, 55,000 that, that were already, should a been included. We needed to find those, get that 91,000 kids under–or in Hoosier Health Wise Insurance Program as quickly as possible, and had a great outreach program with county coordinators, county plans, all kind of other groups, whether churches or schools, or doctors or hospital, and, certainly, the success is just–has been very, very gratifying. Instead of 91,000, we now have over 114,000, and, and more than, than our census population survey said there would be. So it’s been very successful, we’re very glad about that, but it’s got us a little over our, our limit, so we’re looking at ways to, to finance that.
But I think it goes to the basis of everything that we do here in a state, and that is to make sure that every citizen reaches their full potential, starting when they’re born, and leave the hospital with the programs that we have to help that brain develop the 90 percent those first three years, into preschool, into kindergarten, and reading, and all that. To do that, a child has to be healthy. A child, and the, and the concern of the family, has to be a healthy family, with that. But that child is basic because they’ll go through their years to reach their full potential to have a very satisfying and, and fruitful life, but also to be a part of the workforce here in the State of Indiana, or wherever, that they can be productive citizens, and, and raise their own family, healthily.
SUSAN DENTZER: You really cared about getting coverage to kids.
GOVERNOR O’BANNON: Well, you know, I came in as governor and we started looking at early childhood development, early childhood entertainment, and, and it told us all this is the basis to build on. If we’re gonna have a better education system, the child has to be healthy, it has to be stimulated, it has to be loved, it have to, to be played with, and talked to, and sung to, in ways that they, they grow in their minds, and as well as their physical health.
So it’s the basis of everything–everything else comes off that. A good education, a good job, a good family, a good community.
SUSAN DENTZER: Now, as you mention, enrollment has exceeded expectations and that’s a very happy development in any–in many respects. To what do you attribute that?
GOVERNOR O’BANNON: Well, I think we put together a real strong group of people all over the State of Indiana and said we need to reach out in, in ways that are–that will touch everybody, and get to every corner, and get to every situation, whether it’s in school. Some schools have already started picking up those kids that were falling through the crack, with other money, and they knew exactly what we’re talking about.
We did it with a–ran in a multipage form, one sheet a paper, front and back. You could apply an–and, certainly, answer all the questions very quickly. We trained our case workers all over the state. We trained others who could take the applications in, and then we advertised whether it’s television, radio, billboards, other ways–pamphlet handout, and it was just a remarkably successful outreach that really made a difference in a very short period of time–about a year and a half.
SUSAN DENTZER: As we mentioned, again, a moment ago, this has had fiscal implications attached to it. The Medicaid budget, alone, is up about a third over what it was in 1998. How have you been able to maintain support in a state that’s known for being fiscally conservative, for this fact, and maintain support for the program expansion in light of that?
GOVERNOR O’BANNON: Well, I think being fiscally responsible means that you’ve got to have the healthiest state and the healthiest people and the healthiest students, and that makes just plain good common sense, and so these are dollars we can spend, and, and make sure that we have a, a strong program for, for the health of the kids, that’ll pay off in the long run, or keep us from having other expenses in long run. So it’s just good fiscal sense, and common sense to move forward in this way.
SUSAN DENTZER: And you’ve had bipartisan support–
GOVERNOR O’BANNON: Yes.
SUSAN DENTZER: –for that line of thinking. Why?
GOVERNOR O’BANNON: Well, I think it’s in, one sense, a no-brainer. I think all of us, in either party, certainly think that this is the basis, it makes this state stronger, will make it greater, and if we can’t handle the health of the, of the smallest, or the health of, of the student, then we’re, we’re gonna pay for it later. But, more importantly, that each individual child can reach their full potential in a–with a quality of life and a, a healthy body and mind, that will make a difference to them as well as it will to their families, later on, or to, to our workforce.
SUSAN DENTZER: Now despite the enormous success in CHIP, to date, there remains some parts of the program which probably could be improved. One issue is could provider payment be increased? The pediatricians of the state are arguing that their payment is too low and that’s had a result, impact, in terms of how many providers want to participate.
Case workers are paid relatively low salaries. That engenders a lot of turnover, particularly in a state with low employment as this one has.
So it seems as if there is a prospect of having to spend more to make the program better in the future. Do you think you can maintain support for those kinds of measures as well?
GOVERNOR O’BANNON: Oh, I think we will look at that very seriously, and, and certainly try to support ‘em in ways, and I–that we have in the, in the past. Also, the panel will continue to look at that and we’ve got business people included in looking how we can meet those–as far as the caseworkers, when I first came in ’97, we started to increase from 8 percent a year, and we have done that over the, the second–second two-year budget period, too. So we’re trying to raise those up, so we can attract ‘em, if pay is, is a big part of it, and, certainly, they ought to be reimbursed.
So we’ve tried to raise those up as far as government employees. Then we continue to look at what the reimbursement to the providers are and see that we can make adjustments, that make us–makes it important that they be a part of the program and can be paid what would be proper.
SUSAN DENTZER: Given that many people in this state, as obviously is true elsewhere, remain without insurance, tending to be adults, very often parents of the children who are now in Hoosier Health Wise, single and childless adults as well, and undocumented immigrants, you have essentially now asked one panel, headed by Peter Sibinsky [ph] to look into further coverage and expansions.
GOVERNOR O’BANNON: That’s right. Other populations and–
SUSAN DENTZER: What do you think the options are for covering more people in Indiana?
GOVERNOR O’BANNON: Well, I think we have to know who they are and how many, and, and what the cost would be. I think that’s always a consideration because it–the money only goes so far, and how much the Federal Government can participate in thinking in the same direction that we are.
Certainly, I feel that everyone should ac–have access to, to quality health care in this state, and, and everyone, and every place else. But there is a ways to work into that, and I think we’ve taken some big steps, the last three years, and certainly we’ll look at family coverage as we go into these next years, ’cause it’s very important. Some states have already taken that step.
SUSAN DENTZER: One proposal, obviously much talked about now, partly because it’s been advanced by Vice President Gore, is expanding CHIP to cover families. Is that an approach that would appeal to–
GOVERNOR O’BANNON: I think that would move a lotta states forward very quickly on, on covering families. That would be very important because it would give the resources that are necessary to, to cover that, that additional population.
SUSAN DENTZER: What about the fiscal limits to doing just that, to broadening coverage? I know you’ve had a budget cycle here, now, where you vetoed additional spending, in part, because revenue projections did not bear out.
Do you think you’re bumping up against any fiscal limits that could impede expansion?
GOVERNOR O’BANNON: Well, let me say you always bump up against fiscal limits in every budget, and every state has, because there’s such a demand, and programs that are very, very important–everything from building highways, or, or schools, to, to taking care of those who are most vulnerable in our society, to improving education, teacher quality. All those things come forward at the same time and there’s never enough resources to, to pay for all, so you have to really balance that, but I think of all things, the health of the community is the basis, and I think that’s why we used our–over $100 million that we’ll get over each year for tobacco settlement. It’s all health-related, and the CHIP program’s a part of that, and prescription drugs for seniors is a part of that.
Certainly, keeping young people from smoking and be more healthy is part of a big expenditure we’re making, and that way, as far as–and setting up community health centers in rural areas, and urban areas, where they’re needed.
So we continue to force the issue of how important health is to this state and to each community, and to each person, to reach, certainly, a quality of life that’s–make them productive and happy.
SUSAN DENTZER: How much is any of this likely to be an issue in the now underway, and coming, election campaign?
GOVERNOR O’BANNON: Well, I think, I think it’s, in a sense, we look at it as a very bipartisan program that everyone should be a part of. I think the–that the paying for it, or the balancing against other programs could, could–that’s an area for some debate.
But I would not expect anyone in a campaign not to be for certainly including more people with health insurance, so their families can be healthier, and our economy can be healthier in, in the long run, with the, with good people, here, in Indiana.
SUSAN DENTZER: Governor, there’s been a surge of undocumented immigration into this state in recent years. Let’s talk a bit about that, and then, specifically, how you think the health care needs of undocumented workers can be addressed.
GOVERNOR O’BANNON: Uh-huh. Well, you need, can be concerned about anyone’s health, and, certainly, we went through the period of time with migrant workers coming in the state, and we worked on that, and certainly made it avail–available to them, and I think any new people coming in should, should be available, if they need health care, have different points of entry that they, they can get that, and I knew–I know we do with our hospitals here, and, and we’ll continue to do that.
When it comes to illegal aliens, then I think we have a problem ’cause the Federal Government says you cannot use money for that.
So I think we need to look at ways as–if they’re gonna be–become productive citizens in a community, has then to make sure, in any way we can, that they’re healthy, ’cause they’re serving us or working for us, or doing things, and, hopefully, that they can become legal.
SUSAN DENTZER: So you think there needs to be some steps taken on the federal level to deal with this?
GOVERNOR O’BANNON: Well, really, as far as being able to use the funds we have in the, in the CHIPS program to, to take care of those children, but we’re not gonna leave anyone without some kind a health care in any emergency, and that’s–we have other ways we do that here in the state.
SUSAN DENTZER: You were telling me, just a moment ago, about the increase that you believe has taken place in the Hispanic population of Indianapolis. What do you think has happened?
GOVERNOR O’BANNON: Well, I think there’s jobs. I think Indiana is one of those states that have unemployment that stays under 3 percent. It’s a lot of opportunities here for, for work, and I think it’s a, it’s a strong group a people that are growing here in Indianapolis, but also in Northwest Indiana, South Bend, and other places in the state, and it’s just part of that strength that’s being added to the State of Indiana, that we have a strong work ethic, a strong workforce, and a very, very good state that’s moving forward with a strong economy, and they’re a part of that.
SUSAN DENTZER: And the numbers in Indianapolis alone, you were saying, have risen from–
GOVERNOR O’BANNON: Well, we don’t know. It’s probably gone up ten times in the last ten years. I don’t know–between 50- and 100,000 now, just here, in Indianapolis, and so it’s a important part of our community now, and certainly there be–we–adding their leadership, and their, and their workplace here in Indianapolis.
SUSAN DENTZER: When all is said and done, what would you like to leave off as having accomplished in terms of coverage of the uninsured?
GOVERNOR O’BANNON: Well, I think, I think we gotta continue to push forward to cover all–to cover more people who are uninsured, and, hopefully, at some point, make sure no one’s uninsured as far as health care. It’s a basis, it’s a foundation for, for a productive, for a healthy community, for a safe community, and if we don’t address those health care needs, then we’ll be addressing problems later on.
But, more importantly, for each person, we, from a standpoint of, of public service to that person, make sure that they have the healthy life and can reach their full potential in any way that they, they can, with the, with that support. Then it’s up to them to make it to, to their great success.
SUSAN DENTZER: Thank you very much, Governor.
GOVERNOR O’BANNON: Okay. Thank you.
SUSAN DENTZER: Thank you.