A major Medicaid overhaul proposal.

Democrats outline their priorities for 2025.

Plus, calls to defund Indiana University and more.

From the television studios at WFYI, it's Indiana Week in Review for the week ending January 10th, 2025.

Indiana Week In Review is produced by WFYI in association with Indiana Public Broadcasting stations.

Additional support is provided by the Indy Chamber, working to unite business and community to maintain a strong economy and quality of life.

This week, Indiana Senate Republicans say one of their top priorities in 2025 will be a major overhaul of the state's Medicaid expansion program.

The Healthy Indiana Plan, or Hip.

There are currently more than 680,000 Hoosiers on Hip.

The state's Medicaid expansion program for low income adults without disabilities.

Senate Republicans want to cap that program at 500,000 people, with everyone else moved to a waitlist.

Republican Senator Ryan Mishler says people removed from the program could access insurance through the federal health insurance marketplace.

So there shouldn't be anybody that would totally lose coverage altogether.

Proposed changes to Hip also include a lifetime limit of 36 months on the program.

Mishler says his caucus also wants to create work requirements for many Medicaid participants, meaning they'd have to have a job or be actively looking for one to keep their coverage.

Such requirements have previously been struck down by federal courts.

Is this the right path forward for Medicaid?

It's the first question for our Indiana Week in Review panel.

Democrat Ann DeLaney Republican Mike O'Brien.

Oseye Boyd, editor in chief of Mirror Indy And Niki Kelly, editor in chief of the Indiana Capitol Chronicle.

I'm Indiana Public Broadcasting statehouse bureau chief Brandon Smith.

Ann DeLaney, lawmakers say they've got to curb Medicaid spending.

Is this the best way to do it?

You know it is.

It is the typical way to do it.

I mean, you come up with $1 billion shortfall and what do you do?

You balance the budget on the backs of people that are least likely to be able to pay for it.

I mean, people on Medicaid are not making money.

They're barely subsisting.

Okay.

And what we're going to do is going to take the health insurance away from them.

It just it it so lacks vision, which is a term I don't really like to use.

But it so lacks vision that it's incredible.

They lurch from crisis to crisis to crisis.

Okay.

Instead of planning out, we're going to have a windfall in a few years when the pension liabilities paid off.

You think we could come up with a plan that doesn't cut taxes over five years, but increases the ... the lives, the health, the employment of average Hoosiers over five years.

Could we come up with a plan to really start increasing K through pre-K and childcare?

Could we come up with a plan to make Hoosiers healthier?

Could we do anything that makes lives, lives of Hoosiers better?

Republicans don't even want to look at that.

All they want to do is say, oh, we have a shortfall.

We're going to still cut corporate taxes.

We're going to still spend $100,000 an acre to buy land for economic development, and we're going to make poor people pay for it.

It's great.

Just typical Republican.

Is this going to get is this move going to get to the savings that they kind of need to have in order to make the budget work.

For the programs?

90, 90% of it's paid for by the federal government take on the state and get in the Wayback Machine.

We raise the cigaret tax to pay for it, or at least pointed it to pay for it.

it's a pretty blunt response, but it's also, I think, reflective of the risk of the Medicaid program engulfing the state budget.

And this is before and that's without the feds changing anything.

There's been hints that the Trump administration may change something in terms of their, you know, in terms of the subsidies or the support for, for Medicaid expansion plans, which is what the Healthy Indiana plan is.

It's the it was the most administratively complex, expensive and only political path forward to expand Medicaid in Indiana ten years ago or 12 years ago.

to get lawmakers to do that because they weren't going to we weren't doing Obamacare, Medicaid expansion.

We could do Healthy Indiana Plan 2.6.

That was missed.

That was Mitch Daniels idea.

But if you go all the way back to that, was that was Medicaid expansion before Barack Obama even got elected in Indiana.

That was unique.

That was a unique plan to Indiana.

It was supposed to be capped at 45,000 Hoosiers.

We thought the healthy Indiana plan, 2.02.0 would cap out around 200,000.

We have 657,000 on it.

you know, so even at 10%, if you're Ryan Mishler, you're looking at this number just to do this.

Yeah, for the whole program, for a 20.

But it's a $21 billion program in the state with federal money included.

so when we had when we had the $300 million hole, that was a 1% miss.

So if you if your margin is 1% and it's going to engulf your $300 million, you're increasing in K-12 education and the other things you want to do, you've got to try to control it some way.

Is this the way to control?

Is this the.

People who.

Need it?

Is this the way that control should be?

It?

I would say no, it's not the way to control it.

to Anns point.

And I've said this before.

There's no comprehensive looking at how do we actually budget, how do we actually plan to help people?

How do we put money in pre-K?

How do we actually cut money for Medicaid?

We are doing this on the backs of poor people.

And that, I think, is where that is.

The issue is, and they're working people.

Correct.

These are not people who are not working.

So therefore, if they are workin to actually have insurance or they don't have insurance, what?

Where's the where's the, worth the fix here?

Because it's not just oh, take them off of Medicaid because then what's going to happen?

What's the long term plan for that?

Then they just stay unhealthy and keep going to emergency rooms.

And then we're paying for it in that way.

There's a cost and there's a long term cost.

And what is the short term?

It was a long term.

We never seem to have this idea of thinking about ten years from now to.

That point to to that point for tax cuts.

We see, you know, okay, so that's nearly 200,000 people.

If this bill just went through.

We haven't seen the text of the bill yet.

Yeah.

So we're basing this off of the discussion.

But let's say about 200,000 people are suddenly removed.

They have their health insurance taken away.

They would be eligible for the federal marketplace, but that's if they can afford what's on the federal marketplace.

If not, they're left without insurance and they go to the emergency room for care, which is what we saw for years and years.

If the marketplace even exists, that's a good point to, well, going to the emergency room and getting care, not being able to pay for it means everybody else's health insurance in the state goes up, health care costs for everybody else go up at a time when they're already higher than they are in most other states.

You know how they got HIP 2.0 passed partially was they got hospitals involved.

And I want to point out the 90 - 10 and where we're going to save money.

We're not going to save money because that ten is paid for by the hospitals through a hospital assessment fee.

Right now, mind you, I guess you could spend that elsewhere, but I assume the hospitals would say, whoa, you know, we're not going to pay a fee that was meant to cover people so that we wouldn't have to provide services to people who can't afford it.

So it's like this vicious cycle.

Meanwhile, we've got this much larger pot of people in the traditional Medicaid program.

That's where the money is being spent.

40% of the costs of Medicaid are in elderly.

Yeah.

You know, and I don't I don't hear anything on that.

So, you know, panels.

Death panels remember.

I don't think we're bringing.

Those contracts.

Holden has said in the past, you know, one that some an example, something they need to get control of is all these people putting all their assets in these trusts, right.

So that they can give an inheritance to their kids.

And meanwhile, the state is stuck paying for every penny of their care when they're 70 years old.

And so that's an example of something that's a perfect.

That's a perfect way to solve money.

It it's not it's it's not moral for them to do that.

And it seems to me the legislature could really step in on that and then see what happens.

Well, you and Travis Haldeman fight that fight together.

That'll be my.

I'm sure my, my okay on that will carry that bill right.

Right through to the governor's desk.

Time now for viewer feedback.

Each week we post an unscientific online poll question.

And this week's question is to curb Medicaid spending.

Should Indiana limit the number of people allowed on the Healthy Indiana plan A yes or B no?

We asked you way back in December, should Indiana fire the consulting firm that generated the billion dollar Medicaid forecasting error?

62% of you say yes, 38% say no.

If you'd like to take part in the poll, go to wfyi.org/wire and look for the poll.

Maybe Milliman was hitting no.

Over and over and over again.

The state House and state House Democrats this week said their focus for the 2025 session will be helping working Hoosiers get ahead with priorities that include health care, housing and public education.

House Democratic Leader Phil GiaQuinta says his caucus wants to address the rising cost of living, from housing to health care to utilities, and on the health care front.

GiaQuinta says Republicans have been fixated on hospitals as the cause of high health care prices.

It's time to take on insurance companies for their role in rising costs and cut the paperwork.

Red tape.

Both House and Senate Democrats want to significantly increase public education funding, increase access to pre-K, and end Medicaid waitlists.

Senator Andrea Hunley says these issues are not just moral priorities, but economic imperatives.

Quality schools attract businesses, create skilled workforce, keep young families in our state.

Senate Democrats priority bills include supporting maternal and infant health care and banning wage garnishments and property liens for medical debt, and allowing tenants to withhold rent if landlords don't make essential repairs.

Mike O'Brien.

Are Democrats going to find more bipartisan support this year for going after something like insurance companies to tackle health care costs?

As a veteran insurance lobbyist it's always bipartisan to attack insurance companies.

But in the run, the focus has been it seems like the focus in the legislature has been on hospitals for a little while.

What are we going to see that start to shift now?

Yeah.

I think the question over health care costs in Indiana has been asked, why are they high for the last five years, since we had this first study, that the hospital costs in Indiana were among the highest in the country.

So naturally, the legislature's focus, the political focus, turn to turn to hospitals first.

but it's also they've also woven in what are PBMs up to?

How does how does that work?

You know.

Ed Charbonneau, the chair of the health committee, has he's got the most poignant question that no one can answer.

When a pill gets manufactured, what happens between the time it comes off the conveyor belt and I put it in my mouth and nobody can answer it.

You go sit in a committee hearing.

You ask that question two hours later, like you have literally no idea what happened.

You're like, you have less of an idea what happens now.

So the legislature has been trying to unravel that, for some time.

And, you know, from the House Democrats standpoint, it's, you know, it's, you know, politically, you know, popular to go to go ask that question.

It's been it's been asked.

And so, yeah, we went from really focused on hospitals to now focus on on insurers.

And you know, politics.

You know Partizan ideology is suspended in the health care debate largely.

I mean, we just had it with Medicaid, which is a little different when you're talking about the government provide it, but you're talking about the government controlling the cost.

There's really no limit to what Republicans are willing to use the government for to to limit that.

Jim Toms, very conservative member of the Indiana Senate, has a bill to cap insurance premium increases of 10%.

Right.

As an example, it's like that's a pretty blunt like way to try to control costs without any understanding of why the why, why, why might have to go a bit more to begin with.

So it's the right question to ask.

But I mean, is that kind of a response from someone like Jim Toms is just fine.

Let's just do this.

Is that kind of because we've just been asking a question and not just.

A no one has a clean answer to it.

Yeah, because of that.

Is that where this moment has now brought us to, which is they're starting to really contemplate blunt tools.

Well, anyone who's ever dealt with an insurance company for medical treatment, it feels the same way, feels the same way.

My daughter, who's a physician in Saint Louis, is a concierge physician.

She doesn't take insurance.

People can submit it themselves.

But she said that she was tired of being told by an 18 year old high school graduate that the procedure she was recommending wasn't necessary.

Okay.

Or increasingly now, of an algorithm.

Well, exactly.

Exactly.

At this point.

And so you it's it's a sense of frustration and, you know, it kind of brings you back to the whole question is why we have private insurance and why it's related to the fact that we work.

I know it's historically the way it developed through unions and and employers, but does that make sense anymore?

And, and and having a system like this where you, you have to shop virtually every year if you're an employer, I have to shop my insurance each year.

And the only constant is it's going to go up and the coverage is going to go down.

Those are the only constants in the debate.

And so yeah, the frustration level is high.

And it's going to wield some effect on insurance companies.

Whether it's the most effective way is a question.

But it's going to show some repercussions.

and it isn't just insurance companies.

It's also like, Mike just talked about the pharmacy benefit managers.

And basically as great.

So that's going to put all of the players, not just one party.

but are they going to find perhaps a more willing partner in some of these measures in the new governor than they have in the past administration?

And Mike Braun?

Yeah, I mean, Mike Braun obviously seems like he's willing to go a little further than the super majorities have in the last couple of years.

They focused on transparency, but I feel like everyone's getting frustrated, like, okay, we've done all the like low hanging fruit, right?

And and we're not seeing any different.

And I also get their frustration because it's also national.

And these are national forces that are hard for Indiana lawmakers to cut through.

It's not where you go.

I mean.

Exactly.

Like a fact, mostly.

Right.

Because of that.

And so, you know, I mean, they're they're going to try new things and I, I applaud that.

but yeah, stuff like setting limits on insulin and limits on how much your premiums can go up.

I mean, that's where we're coming to now because nothing else seems to be working.

And realistically, kind of to the point that Niki just made our Indiana lawmakers in an almost impossible position where their their constituents are rightfully demanding answers and action.

But there's only so much at a state government level that you can really do.

Well, I wonder how much that that needs to translate to the federal level from us talking about the state level to actually moving into Congress and saying, okay, this is work our constituents are saying in Indiana in general, what can we do on the national level to actually kind of create a cohesive, solve to this problem?

Because what we are finding is people are really tired of the medical system, and I don't want to I don't want to like, crack on one particular area, not just because it's not just insurance and it's not just, like I said, 18 year old, they're just doing their job, right?

They're just doing their job.

They were told to do no.

Yes.

And so it's the whole system entire in its entirety that people are just when you get the bill, you people don't even want to go to the doctor because they don't want to get the bill.

Yeah.

And the politics of the starts are hard because you're not lowering health care costs.

You're lowering the increase.

Yeah.

That's that's you're constantly arguing and negative policy space.

Yeah.

In the sense that you're like well we're going to go up 12 only go up nine.

Yeah.

Yeah yeah.

Yeah.

Victory right.

Victory as we age and get unhealthier.

But it's and it's also and the, the other part of the political problem there is well instead of going up 12 it only went up nine.

Well how do you know it was going to go up 12.

Yeah.

It's, it's, it's the department store saying, oh everything's on sale after the week before.

They jacked things up walking with their tea.

Exactly, exactly, exactly.

I wasn't going to call out a particular retailer, but yeah colleagues does that a lot that that's true.

It's also several state officials are calling for the elimination of state funding for Indiana University, with their objection being IU's remaining connections to the Kinsey Institute, state comptroller, at least initially.

Representative Larissa Sweet and the other critics say that IU has not followed state law mandating complete separation from the Institute, which focuses on sex and gender studies.

Sweet led the charge to cut all state funding from the Kinsey Institute in 2023, but these officials say IU's lack of compliance should result in the removal of all public funding from the university.

Nichols says IU should be completely separate from the Kinsey Institute.

It goes to the website, it goes to wages, salaries, benefits.

It goes to everything janitorial services or utilities.

IU has maintained that the Kinsey Institute no longer uses any state funding, and that the university has always followed the law.

Nicki Kelly, is this an idea that will gain traction in the General Assembly?

Gosh, I don't know.

I mean, the fact is, is that, you know, as a state, we're very proud of IU and its stature and its research capabilities and in the health care industry.

And so, you know, that's going to be a tough sell to try to defund an entire university over one small department, basically, that they've separated out a lot of the funding.

They've gotten private funding.

They're paying them rent.

You know, I don't know that there's a way to 100% do it.

But the idea of we must basically I mean, the goal is clearly to close the Kinsey is to down.

And so is that, you know, a game of chicken you want to pay up, literally closing the Kinsey Institute or defunding one of the two flagship universities in the state.

That's a big jump.

The fact that this this is this is the first step on the Christian nationalist agenda, the fact that this press conference or whatever it was, the availability she had was held in a church.

In a church tells you what's coming when Beckwith is head of the Indiana Senate.

And I frankly think that if I were the IU president, I think about going private.

There are only 16% of the of the budget is the state is only 16% of the budget now.

And if you could get them out of the issue of tenure and academic freedom and whether the Kinsey Institute and I think the Foundation ought to have, ought to have a capital campaign to which I contribute to get them out of under the state shoe, because this this isn't going to stop when Beckwith is in there.

There's going to be a whole list of the Christian nationalist agenda being put forward, because the Bible should be the code for Indiana.

I think economic development wise, they would have a problem with this idea gaining traction in the General Assembly.

No.

Well, I didn't think the defunding bill would come up to begin with.

Like the that was a surprise.

I mean.

It got put it in the budget in the first place.

Procedurally it just it they had to let it through or I don't think there was there wasn't leadership support to do it to begin with.

I mean, that was a full vote on an amendment.

And I think I get why it passed on an amendment, because otherwise people are going to use mailers.

But the Senate had the opportunity to pull that.

Out to very quietly.

Yeah, just make it disappear.

And then it never did.

And they didn't.

so, you know, choose your own adventure.

I guess I'm not on this one.

Is this an idea that.

Well, I'll go back to the original idea, the original question, is this going to gain traction in the General Assembly this year?

I don't think so.

I tell you what.

Kinsey Institute has not been on my mind in forever.

it's not something I obsess over, but obviously it is something that they obsess over.

We're talking about down to the janitorial level.

like, that's really.

Are you comment on the books really?

That's really my newt.

I was a little surprised.

Well, I was a lot surprised, I should say, when I saw this, because I haven't thought about the Kinsey Institute.

And like you said, it's.

Where are we now?

So are we going to just want to close something that has, is known for the research that it does because some people don't like it because it's doing what exactly what you're talking about.

We're talking about protecting children, but.

We want children based on history from decades ago, not on anything that's currently being done by the kids.

So weirdly, I mean, the accusations at the time of the amendment were that they're they're studying pedophilia and they're studying rape.

And it's like, well, don't you want to understand those things?

Yeah, stuff so that we can.

Learn.

From hard things and horrible things to go talk about that need to be understood.

And so.

Just in disgust.

Indiana Republican lawmakers have introduced a bill that would dissolve the state's largest public school district, Indianapolis Public Schools, from five Education desk.

Rachel Fradette reports on the bill that also seeks to close four other school districts.

House Bill 1136 states that if more than 50% of students who live in a district are not enrolled in schools operated by the district, then the district must be dissolved.

Each of the five school districts elected school boards would cease operations along with the schools, and the district schools must transition to charter schools by July 2028.

The bill would convert more than 50 schools in the Indianapolis Public Schools district into charter schools.

Jennifer Smith-Margraf is vice president of the state's largest teachers union.

She says this bill would take away parental choice.

It's very difficult for us to wrap our heads around why it is that all of a sudden our state legislature would be pushing to take away a choice from parents.

The bill also targets the Gary, Tri-Township, Union and Cannelton City school districts.

Oseye Boyd, Is this a window into Republicans ultimate goal with public education?

Well, I think we've been looking at that window for a while now.

and the window seems to be, changing public education.

Critics may say dismantle, but I used the word change, as a much, more gentle way of saying it.

But I do think that it is, an opportunity for them to try to change public education.

I don't know that it is going to work, though, because I thought about, how are you going to transport these these kids to school?

charter schools often don't have transportation.

There's a lot of logistical things that seem to be, haven't been thought about just as a way to, like, scare tactic to try to say, and it's also schools that seem to, be in poverty.

So what are we going to do here when, it's not going to we're not going to affect affluent school districts or will when they get there doing what's going to happen, because we know charter schools aren't wanted in those districts at this time.

So this is a slippery slope to I don't think they really know where they're going.

One of the concerns about this, I.

Just want to say that I do think they know where they're going, which is they ultimately want more property tax revenue to be going to charters.

And right now the state is kind of making up the difference.

And so if the state can pull that cash back out of state funding and make local school districts share for transportation, for instance, I mean, that's an example of property taxes for schools that are levied is for transit.

And when I say so, I don't think they know what they're going.

I mean, there's going to be a quagmire at the end of this, right?

Yeah.

It's going to be a disaster.

For the bill as a okay.

If you guys don't come to the table and really start talking about how this will work, where we can fund charter schools equally with property taxes and state funding, then we'll just do this.

Is this really just about negotiating?

Well, it ought to be.

In my husband's district.

They have public schools.

There are waiting lists to get into the site.

More the Butler Lab School, 8470 people are desperate to get their children into that.

And all this has been is supposedly about choice for the last 15 years.

They want to take that choice away.

Yeah, I want to I want one more thing I want to ask about that is I remember the early days of the school choice debate here in Indiana going about more than.

Failing schools and poor, and.

Then not about that so much, but about charter schools specifically.

They were sold as better.

We can do this, but they are public schools.

But we can do this better for less.

Yeah.

And we just thrown that out the window where they're exactly.

Kids and failing.

Schools.

So we don't accept that charter schools can close at any time.

And they do.

But I think it views those kids as part of their network, too.

It's the 31,000 in the in the innovation network, in the charters, in the 21,000, the district.

I think the the speaker and Jake Tesco brought this bill is on the education committee.

I think what they look they look at it and go, you're down 4000 students and you're up $50 million.

So how do we drive efficiency in that, in that network?

And I think Doctor Johnson, the superintendent IP, is for solving that question.

and bringing efficiency to, to IPS.

I don't think this is some inevitability where it's like, okay, well, we created choice and you're you're rolling drops now we dissolve you.

I think this very much was to to get IPS at the table in a way.

They want to come on the tail.

They have a new board.

They have 40 members on the board.

There are four very progressive in terms of like the reforms they want to bring to the district now.

And I think you're and I think you're going to see the legislature before this is over in the next few weeks.

You're you'll see, I think IPS in the state partner on this.

Issue this way.

And why are we always kicking IPS?

It seems like IPS is always a target.

It's the.

Largest.

It's the largest.

It's still but the other the other thing is, besides the fact that they lied to us about failing schools and and for children to sell this initially and lied about the fact they could do it cheaper.

All right.

We don't even know they can do it better.

All right.

That that is Indiana Week in Review for this week.

Our panel is Democrat Ann DeLaney Republican Mike O'Brien.

Oseye Boyd editor in chief of mirror Indy.

And Niki Kelly of the Indiana Capitol Chronicle.

You can find Indiana Week in Reviews podcast and episodes at wfyi.org/iwir or on the PBS app.

I'm Brandon Smith of Indiana Public Broadcasting.

Join us next time because a lot can happen in an Indiana week.

The views expressed are solely those of the panelists.

Indiana Week In Review is produced by WFYI in association with Indiana Public Broadcasting stations.

Additional support is provided by the Indy Chamber Working to unite business and community to maintain a strong economy and quality of life.