(Muisc) Mike Braun's health care proposals.

Jennifer McCormick's economic development proposals.

Plus the cost of the child care shortage and more.

From the television studios at wfyi, it's Indiana Week in Review for the week ending September 27th, 2024.

Indiana Week in Review is made possible by the supporters of Indiana Public Broadcasting stations.

This week, Republican gubernatorial candidate Mike Braun released a health care plan that would expand on past legislative action, including some policies that failed during the last few legislative sessions.

Indiana Public Broadcasting's Abigail Rubin reports.

Braun's plan includes prior authorization reform regulations for pharmacy benefits managers and, among other things, a ban on non-compete clauses.

The plan positions prior authorization reform as a way to enhance transparency.

While reform was a key part of the Senate GOP policy priorities during the last legislative session, Republican lawmakers ultimately killed a reform bill due to fiscal concerns.

The plan also proposes banning non-compete clauses for licensed medical personnel in not for profit hospitals, which builds on the Federal Trade Commission rule that banned them in for profit settings.

The legislature did pass a ban on non-compete clauses in 2023, but only for primary care doctors.

Braun also wants to regulate pharmacy benefit managers.

Lawmakers passed a bill last session that added some transparency measures for the third party administrators, but didn't add any regulations beyond audit.

Can Mike Braun push lawmakers to take bigger steps on health care?

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

Democrat Ann DeLaney.

Republican Whitley Yates.

Jon Schwantes, host of Indiana Lawmakers.

And Niki Kelley, editor in chief of the Indiana Capitol Chronicle.

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

Ann DeLaney, can new leadership in the governor's office push the General Assembly to go further than it's gone?

No.

Okay, first of all, I'm glad to see that he's agreeing with the Obama Harris, excuse me, with the Biden-Harris administration, because he's worried about the pharmaceutical, benefit managers group and the federal government's already filed suit against the three biggest ones of those.

That's going to be resolved federally.

The other thing that's going to be resolved federally, it seems to me, is the prior authorization, the idea that you could push the super majority who hasn't wanted to touch this issue, into going against anthem, who's what, a half mile down the street or against Lilly is another half mile down the street is not realistic.

Some of these things are going to be resolved federally.

I think he's right about the non-compete.

The non-compete ought to apply to all doctors across the board, not just not for profit hospitals, but all hospitals and and the, and having stopping 18 year olds from second guessing a doctor's prescription for, for in a prior authorization.

That makes sense.

But again, these are things I think that the federal government is going to deal with.

I know our high our health care costs are high.

Look at our population.

We have a lot of diabetes.

We have a lot of smokers.

We have a lot of obesity.

We have problems that we need to address fundamentally with our population.

If we're ever going to get those health costs into manageable positions.

And that is something Braun has talked about too, is is the shift towards prevention instead of just, just radiation, just treatment?

can I mean, the legislature has nibbled around the edges on some of this stuff.

It's it's offered these bills.

It hasn't really gone that far in any of these areas that Brian is hiring or in most of these areas, Ron is highlighting.

Can the governor being a loud voice for these things, make a difference in the statehouse?

I absolutely think that they can and that they will.

And you have to remember that he's been a proponent of health care prior to the Biden administration.

He's been speaking about these things, and he has real life experience in managing the health care of his own small business.

And so utilizing that real world experience, as well as his relationships with the legislature as well as his experience specifically in Congress with federal legislation, I think makes for the perfect storm and getting stuff like this passed.

Yeah, I don't think I don't think he's going to carry very much weight with the legislation.

And you think Jennifer McCormick will?

Oh, she does.

It has the relationship to these.

I think that most of these are going to be resolved federally, as I said.

Which is where he is right now.

They're going to control the legislature.

The next time around and will get done.

Jon, do you think the governor and the bully pulpit that the governor will have, regardless of who's in the office, can push the general Assembly further than they've been willing to go?

he can push to a certain extent, but I don't think necessarily if if leadership and the supermajorities if in fact, they remain supermajorities.

And I guess we'll find out soon enough about that.

don't want to embrace these for some of the reasons that have been mentioned, either the strength, the lobbying strength of an anthem or the cloud of an Eli Lilly.

Well, then I don't think he carries the day.

I think there would be, this quaint notion of compromise.

There would be elements of his plan that probably would be embraced.

Transparency generally seems to, resonate with members of the General Assembly and with the public.

we've seen attempts where you have estimates, you know, versus, actual quotes on costs.

so how far do you go in that continuum?

you know, it strikes me that a lot of the things he's proposing and they are certainly on the transparency front, things that he has advocated for and won and in fact, his, Hospital Transparency Act, part 22.0, which he introduced in December, has is by bipartisan support, including Bernie Sanders, who has a co-sponsor.

so he's shown an ability to work across the aisle on this issue.

But whether that helps him, he doesn't have to work across the aisle on this issue.

He has to work on his side of the aisle, which is which can be challenging.

And Senate President Pro Tem Roderick Bray, speaking at an Indianapolis Business Journal health care panel this week, was talking about the high health care, was asked about the high health care prices and pointed to this, you know, this transparency portal that we talked about here on the show a few weeks ago.

It's finally launched this year.

And I think his message was kind of like, well, let's see what the data starts to tell us now that we finally can see this data and see, is this going to be another session of, well, let's see what the let's see what the numbers tell us.

Gosh, I don't know.

Maybe I mean, the fact is people are struggling.

And so, you know, they've worked around the transparency sides for a couple years now.

And I think the fact that Mike Braun is coming in with a much bolder stance on these things is pretty impressive.

A few smaller issues that are in that plan, which I thought are fascinating, are allowing the attorney general to actually block mergers and acquisitions because, you know, so much of our health care is monopolized at this point.

And also, there's a fascinating idea he had about trying to encourage more primary care facilities to be built by creating a revolving loan fund, funded by the EDC.

They seem to have all the money in the world, so maybe they can help out there.

We also have to attract doctors.

And when they take the positions they take on abortion and LGBT rights, all these doctors are telling us it's difficult to recruit new people to Indiana.

That's probably one of the best help we have, one of the best med schools, and they.

Leave once they are educators.

I agree it's a great med school.

But if they don't.

Practice in Indiana.

It is one of the largest.

It's one of the biggest.

And so we can, in Indiana, incentivize people to not only stay here, but to live here and.

To quality of their life makes a big difference for another.

Provision.

That's kind of a sleeper in there.

That caught my attention and that is having strict metrics for outcome.

outcomes of different types of medicine, which some the cynic would say, oh, weren't those like death panels where you can decide what what medicine can't be rendered or you know, in 65% of cases, the 85 year old patient doesn't need this treatment because it's not going to work.

Now, I'm not saying he's advocating that, but when you start talking about setting up metrics that predict outcomes, that suggests that somebody is not going to get the care that he or her and that person's family wants.

All right.

Time now for viewer feedback.

Each week we post an unscientific online poll question.

And this week's question is, will the Indiana General Assembly take meaningful steps to reduce health care costs in 2025?

A yes or B no.

Now, last week we asked you who will win the Senate race for governor.

We had a huge spike from our normal response rate 66%, say Republican Mike Braun, 29% say Democrat Jennifer McCormick, and 5% say libertarian Donald Rainwater.

If you'd like to take part in the poll for the FYI mortgage wire and look for the poll, Well, Democratic gubernatorial candidate Jennifer McCormick says Indiana needs to refocus its economic development strategy.

McCormick unveiled proposals this week that she says prioritize people and not just businesses.

McCormick says state government has spent too much time focused on certain regions, creating pockets of success.

We still have 92 counties that we need to pay attention to.

McCormick's proposals include more local input into economic development strategies and better support for existing Indiana businesses.

Notably, smaller ones.

McCormick also wants to spend more on tourism and quality of place projects like affordable housing and cultural amenities.

She says finding the money for that involves changes at the Indiana Economic Development Corporation.

The blank check book, and the question of spending and the lack of transparency and accountability and the question of our natural resources.

There are a lot of pieces to.

That that we need to rein in.

McCormick also wants to reduce the length of time that new businesses receive tax breaks for locating in Indiana.

Whitley does Indiana's economic development strategy need a significant shift?

I think you have to look at the candidates.

You've got one that's putting things political platitudes on paper, and then you have Mike Braun, who's a main Street entrepreneur.

Health care plan was the platitudes on paper.

Absolutely not.

He's produced that for his own businesses.

Exactly.

So you've got a main Street entrepreneur who's going to be over economic development, who doesn't come from central Indiana.

So he's going to have a bottom up approach when it comes to how he incorporates the rural counties as well as small businesses.

He's someone that has signed the front of people's paychecks, and his ability to really understand that and leverage the way that he's able to produce jobs as well as increase wages, is going to be seen not only through his private business, but also through his gubernatorial leadership.

The way that Braun and McCormick talk about economic development is remarkably similar in a lot of ways, and in expressing, I think, what we're hearing from voters, especially those who don't live in Indianapolis, which is we need to change the way we're doing it.

Is it going to change?

I think it's I think there is some momentum for that among rural areas in the state.

And I think, I think Jennifer McCormick's emphasis on small business is the way to go.

You know, the top five economic development projects in the state, which are going to cost about $15 billion dollars, okay, they're going to generate 1500 jobs, 1500 jobs.

And what kind of stress are they going to put on our roads, on our water, on our electricity?

All of those questions are there.

And yet there's this huge amount.

When people talk about Bitcoin, it produces almost no jobs, uses a fantastic amount of water and electricity.

Who's going to pay for that?

I mean, we need to look like Jennifer McCormick says it's small businesses and entrepreneurs on the local levels.

I mean, some of the places we're locating, things like, for example, that whole leaf district without the water.

I mean, there are reasons that coal companies located along rivers because water was readily available.

Boone County is not a source of that.

And the idea there I the idea that the IDC would help develop these kinds of medical things, you know, somebody some group that pays $100,000 an acre for it, for a farm maker that's worth $12,500.

It's not my idea of the person who ought to be doing investments in anything else.

Some of this is also how the IDC budget has worked these last couple of years.

Now.

Part of it is because Indiana has been incredibly flush with cash in its last two budgets, largely because of federal dollars flowing from the state.

So that was always going to change a little bit.

But do you think there's going to be a fundamental shift in how that agency gets dollars and can use them?

Yeah, I definitely think, you know, the lawmakers are not going to give them the blank checks that they've given them for these large deal closing funds and performance grants and incentives that they did in the last budget.

I think there's starting to be a little bit of pushback, even among Republicans.

I and I do find it fascinating that both Mike Braun and Jennifer McCormick want to focus on outside of Indianapolis and smaller businesses.

The fact that ITC is really caught up in the capital investment side, but not the number of jobs side.

I think is starting to get noticed by a lot of people.

And so, you know, I think it's great for Hoosiers that we're having those conversations now.

I just I can remember just want to make one point back when in other, gubernatorial campaigns where the cost per job was put out there.

Now, these aren't state funds, okay?

But when you take that $15 million, you're talking about $10 million a job.

A job.

The billion dollars billion to 10,000,000 million.

Thank you.

Yes.

Sooner, sooner or later, it starts to add up to real money.

as I believe the saying goes, the a lot of focus and a lot of criticism of the IDC has been focused, particularly on the Leap project.

But the Leap project is so kind of far down the line now, is that probably going to stay roughly what it is?

And well, obviously we hope we get more companies to locate there.

But other than that, is that really going to change all that much regardless of who's in the government.

Think it's probably a done deal.

And if you look at at, Jennifer McCormick's plan, it doesn't say abandon it, you know, put a road closed sign on it and plant soybean.

And Mike Braun has said nothing like that.

No, I mean her.

She's basically saying, let's not move forward until these questions are answered, until we have questions about water and the environment and the impact and so forth.

But I, I'm to, as you suggested early on, I'm struck by how close together the overarching aspects of these proposals are and how normal, and traditional they are.

I, I thought that there was much more, disparity of opinion and, and rancor.

Rancor.

Let's hope that's a grab is going to say, you know, vehemence, about various views in the Republican primary race by far.

Yeah.

I never thought I would see a Republican primary in Indiana that where it came down on, you know, economic development different because that was one unifying factor for for decades on the Republican side.

But I think this is I think this is from both of them, reflective of the fact that this is what they're hearing from people.

I think it's what they're hearing.

And now it's also they're not running in primary.

That's not as ideological.

It can be more pragmatic.

And it has to be a plan that appeals to, in theory, all Hoosiers.

All right.

A new study this week from the Indiana Chamber of Commerce and Early Learning Indiana, since the state is losing more than 4 billion with $1 billion a year in economic productivity and tax revenue because of a shortage of affordable childcare.

In the study, 57% of parents of young children missed at least a day of work in a three month span because of childcare related reasons, and 40% of parents who had those kinds of work disruptions in the last year said they left the workforce as a direct result of childcare related issues.

In a statement, Chamber of Commerce CEO Vanessa Green Sanders says childcare access and affordability issues continue to hold back the Hoosier workforce and future economic growth.

The organizations also point to studies that show child care helps produce better outcomes, including higher test scores and less likelihood of dropping out.

Jon Schwantes, we saw a report a few years ago that we talked about a lot on this show about the cost of a lack of mental health care, and that produced results of the General Assembly and an influx of spending in that area.

Can this similar report I mean, the dollar amount is almost exactly the same.

Could this study produce similar investments from the General Assembly?

Tis the season for these studies.

When you have a budget year, you have, hey, there's $1 billion gap in highway maintenance between what we, you know, need to keep our growth, you know, on track, in terms of an economically robust state.

This is when we see these types of plans.

And those numbers do get lawmakers attention when you can say, oh, you are losing X amount of money, or the very best case scenario, you're squandering the opportunity to make this much, more, this issue seems to me to be one, that's obvious to a lot of people.

If you look at the fact that their state right now, our capacity for child care is 61%.

I mean, even if if every seat were somehow there was some algorithm that says you're going there and.

You know, made it all work.

Made it all work, you'd still be, you know, half of the essentially half of Hoosiers who need these, this help.

And you also look at some of the statistics in the report where, for instance, federal Health and Human Services Administration says that, you know, they recommend no more than 7% of a family's income be spent on child care in a given year.

But you look at the average in Indiana, which is 8000, right?

It doesn't do much math to say, let's see if 7% is 8000.

That's not yeah.

I mean, there are a lot of Hoosiers families who are not close to close to that and are suffering because of it.

they too could make more money, not only the state coffers, but a lot of Hoosiers.

certainly could could feel that.

Well, it's something if we think about the economies of the future and we're always trying to grow to that.

That's why we're redesigning high school and all that.

If people can't that people don't go into the workforce.

I have to leave the workforce because they're trying to care for their kids.

is this is this is this the session where lawmakers have to take big leaps?

It's going to be hard for them not to right now.

They've kind of worked around the side and talked about regulations and and trying to free up the free market.

But at some point, you know, the areas that are getting are making progress on this issue, are putting direct subsidies in either for parents or for providers or something to spur the growth in this area.

And I think the Republicans in the state have obviously been concerned about that.

But, you know, this is, you know, a report coming from conservative Indiana Chamber of Commerce saying, hey, we need these people to fill these jobs that we have that are empty.

And so I think it'll definitely carry a little more weight into the session.

And I think importantly, it's not just, oh, we're missing out, maybe on some dollars we could otherwise get.

It's we are losing.

We are losing this money.

How much though?

Because I hear lawmakers talk about this.

How much, though does the private sector need to step up when they go, okay, we're going to provide options.

I think the private sector does have a responsibility, but I think the state does, too.

I mean, for example, preschool.

If we made universal preschool available, it would be a huge step.

If we had universal kindergarten available, it would be a huge step.

I mean, those are two years or sometimes three years that parents wouldn't have to be paying for that.

That's a huge gift to families making the median income in Indiana, which is well below what you're talking about, is having a 7% of their income go to health care.

Have on my way pre-K.

So let's not pretend that we don't have that.

But when you look at Mike Braun's plan specifically that he has for rural community, he talks about affordable health care and incentivizing providers so that we can close that gap, because it's not just a child care issue, it's a workforce issue and a quality of.

Right.

And so what did he do for his employees when he was this wonderful employer?

Did he set up childcare for his employees?

I don't think so.

But what he did is he paid a living wage, so they were able to get a.

Living wage and living wage $15 an hour is not a living wage.

How many people did Jennifer McCormick pay?

That builds on something that he said.

And that is how around the edges there have been these attempts to deal with licensure and registration of facilities we haven't had yet, and I hope we don't.

But some kind of tragedy where somebody that was in a facility that formerly would have not met state's licensure requirements or because of the new age requirements, now you can have younger people in these facilities.

You could have them watching more children.

We haven't had it yet.

But if you really want to introduce an unfortunate, tragic wrinkle into this, it would be some sort of, backlash against the, the easing of, of licensure.

And we just.

We just we do that across the board.

We dumb it down rather than pay.

I mean, we do it with teachers.

We have teachers that they wanted to have teaching that weren't accredited.

I mean, we do it all the time.

You know, it's a way we they're pennywise and pound foolish.

Moving on.

Officials from full House resorts, which operates the Southern Indiana Rising Star Casino, made a presentation to the public in New Haven, Indiana, this week.

A small community just east of Fort Wayne about moving its casino there.

Rising Star Casino consistently produces the least amount of tax revenue of any gaming facility in Indiana, and full House, which operates seven casinos in five states, says it's their poorest performing casino.

Full House reportedly told New Haven residents it had already identified a site for the casino.

The move would be subject to state lawmakers approval.

The legislature most recently allowed a casino license in Gary to move to tear out in 2019.

Niki, do you think lawmakers are ready to approve something like this?

I think it's got a decent chance.

you know, we interviewed both chairman of the Public Policy Committee and both the House and Senate.

They seemed very open to it.

They pointed out the distinction versus the last time we were moving casinos, that this is just one existing license from one place to another.

There's no bids, there's no consolidation or expansion, and there's not a lot up in that corner that will cannibalize other and both of them said repeatedly, look, they're gambling, but they're going to Michigan or Indiana or Ohio or Michigan.

So why not have them gamble here?

Yeah, I think the closest casino would probably be South Bend, but that's a tribal casino that I don't think state lawmakers are going to think it was Anderson.

Anderson a little closer.

So there's maybe a little risk of that.

Jon, the last time that they moved a casino license.

the fallout from that is that somebody went to prison.

Actually, a couple people, I think, went to federal prison.

are lawmakers really ready to jump back into that?

I think there's a they don't want to jump into that.

But I do think, as Niki suggests, this is different.

I mean, you're not having the opening it up for bid.

You're not, allowing other people to come to the trough and try to get their, their opportunity.

the dollars involved here are so big, and the and the stakes are so high.

You can understand perhaps why people are trying to cut corners or make sure that they, their chances are enhanced, shall we say, for success.

But in this situation, I think an argument can be made.

We're not doing that.

We're not expanding.

The e word is going to come up.

Is this an expansion of gaming?

Clearly.

it's not.

I mean, it's moving on a license to an area that probably right now there's Toledo Casino, which probably.

Yeah.

That's you cannibalize, that's here would be more than exactly.

And you're right with that.

And that probably is what the casino that would suffer.

well, I do.

I do want to point out one thing, though, because it would you would arguably I'm, I'm sure it would make more money than Rising Sun does now or Rising Star does now.

But Rising Sun, the community where this is what lose out on some pretty important dollars is that going to have to be is making them whole or something like that going to have to be a part of the conversation?

If this happens?

I think that lawmakers need to look at all aspects of this and making sure that in the move, or the transportation, that the community is not left without a void of not only just the dollars coming in, but the jobs.

Yes.

And so I know in Gary there was stipulation about jobs and hiring local and things of that nature.

And so maybe there could be some type of a revenue share.

But I think that legislators need to circumspectly look at this and make sure they're considering all sides before making a decision.

Is the local impact going to be the biggest obstacle to making this work in the legislature?

I don't think so.

It's just not a large enough locale to make a big difference.

Yeah, yeah.

All right.

That's Indiana Week in review for this week.

Our panel is Democrat Ann DeLaney.

Republican Whitley Yates.

Jon Schwantes of Indiana Lawmakers and Niki Kelly of the Indiana Capital Chronicle.

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

Im Brandon Smith of Indiana Public Broadcasting.

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

The opinions expressed are solely those of the panelist.

Indiana Week in Review is a wfyi production in association with Indiana's public broadcasting stations.