Indiana
HIP faces deep cuts as Republicans hide behind Medicaid’s complexity | Opinion
The logic is simple: If you can’t win on policy or public support, you try to win with semantics and confusion.
House passes spending bill — Here’s what’s in it
The House passed a spending bill that would raise the deficit and could put Medicaid in danger.
Even by government standards, Medicaid is notoriously complex — an intricate web of carve-outs, cross-subsidies, and shared state-federal financial responsibilities. I once heard the funding structure of a particular Indiana Medicaid program described as “a house of cards built on top of a shell game,” which feels like a fair description of Medicaid as a whole.
At the same time, Medicaid — especially Medicaid expansion under the Affordable Care Act (commonly known as Obamacare) — is widely popular. This puts conservatives seeking to cut the program in a bind: They must find a way to undermine it without directly attacking something voters support. The program’s bureaucratic complexity provides that opening.
President Trump and congressional Republicans have ruled out major structural changes to Medicaid, instead focusing on cutting more arcane and opaque features of the program, such as eliminating states’ ability to use provider taxes.
Provider taxes are levies imposed by states on health care providers to help cover Medicaid expansion costs. They are critical to funding Medicaid expansion in many states, including Indiana. The ability to impose these taxes is essential for maintaining state support of Medicaid expansion. To justify eliminating these arrangements, opponents have labeled them as waste, fraud or abuse, using loaded phrases like “money laundering” or “bribery.”
It is fair to critique provider taxes as bad public policy, that they are overly complex and/or create significant disincentives for fiscal restraint. However, these mechanisms are a legitimate exercise of state taxation power on actual commerce within state borders, not a nefarious backroom scheme to defraud taxpayers.
This push to end provider taxes is a prime example of using bureaucratic complexity as a smokescreen for deep cuts to the program. By framing it as a technical adjustment that merely enhances efficiency, rather than a direct funding reduction, Congress can obscure the real impact: jeopardizing Medicaid expansion and restricting access to care for millions of Americans.
The logic is simple: If you can’t win on policy or public support, you try to win with semantics and confusion.
Healthy Indiana Plan could reduce care for hundreds of thousands
Indiana’s version of the provider tax, the Hospital Assessment Fee, plays a crucial role in funding Medicaid by generating federal matching funds. This money is essential for maintaining hospital reimbursement rates and supporting the Healthy Indiana Plan, the state’s Medicaid expansion program under Obamacare. The HAF allows Indiana to sustain and expand access to care without relying entirely on state general fund dollars.
The HAF generates over $1 billion annually, bringing in additional federal money that hospitals rely on to care for Medicaid patients. With state lawmakers already concerned about rising Medicaid costs, finding an additional $1 billion to sustain HIP could be an insurmountable challenge.
Eliminating the provider tax may sound like a mild technocratic tweak, but in reality, it would gut Medicaid expansion, destabilize hospital finances, and reduce access to care for hundreds of thousands of Hoosiers. By branding these changes as a crackdown on “waste,” politicians can claim to be protecting taxpayers while sidestepping responsibility for the millions who could lose health care access.
A major threat to addiction services
Over the past decade, Indiana has significantly expanded access to addiction treatment, including residential care, medication-assisted treatment and peer support, leading to one of the largest drops in overdose deaths nationwide.
The heroic Hoosier recovery community deserves the most credit for these wins, and HIP is the policy and programmatic foundation that makes it possible. Traditional Medicaid primarily covers the aged, blind, and disabled. Medicaid expansion programs (like HIP) extend coverage to a broader low-income population.
Most individuals with substance use disorder are both low-income and not classified as disabled, meaning they would have no access to care without Medicaid expansion. The elimination of the HAF — and the likely cuts to HIP that would follow — would reverse Indiana’s progress, severely undermining our fight against addiction.
It is reasonable to argue that addressing the national debt may require difficult choices, including potential limits on Medicaid spending (although that argument is severely undermined when accompanied by a deficit-exploding tax cut).
Likewise, a philosophical debate about the government’s role in health care or Medicaid expansion’s mixed track record on health outcomes is a legitimate discussion. But, if lawmakers want to debate Medicaid expansion, they should do so transparently, without disguising significant cuts as routine and harmless policy adjustments.
Jay Chaudhary is the former director of the Indiana Division of Mental Health and Addiction and former chair of the Indiana Behavioral Health Commission.
MADISON CO., Ind. (WISH) — Surviving members of a highly decorated Vietnam War unit on Monday said group recognition for their service is long overdue.
Company D, 151st Infantry, was an Indiana National Guard unit that deployed to Vietnam at the end of 1968. It was the only National Guard combat unit to deploy as an intact Guard unit during the entire conflict. Unusually for a Guard unit, it had received Airborne and Ranger training. D Company became known as the Indiana Rangers.
Donnie Holland, a member of the unit, said they deployed in five-man teams deep in the jungle, sometimes behind enemy lines. They intercepted supplies and Viet Cong coming down the Ho Chi Minh Trail into South Vietnam.
According to the unit’s official history, its soldiers earned more than 500 individual medals during their year-long tour of duty, including 19 Silver Stars, 175 Bronze Stars and 110 Purple Hearts. This was the highest individual medal total within a one-year period of any Army infantry unit. Missing from the Indiana Rangers’ accolades, though, is any recognition of the unit as a whole. Although the state of Indiana welcomed them home, the Indiana Rangers said there is no record of any official military unit award.
It’s an oversight Holland and other surviving Indiana Rangers said they’re trying to fix. He said he and the others are campaigning for a presidential unit citation, the highest unit award. Holland said unit recognition is important in part because it would commemorate the contributions of support personnel who did not see combat but provided critical services such as maintaining the radios they used to call for fire support or extraction.
“We would not have been as successful as we were out in the field if we didn’t have the support we had in the rear,” he said. “Those guys in the rear deserve that recognition the same as us because they helped us stay alive.”
The Vietnam War took a toll on D Company. Of the more than 200 Indiana Rangers deployed to Vietnam, six were killed: Skip Baranowski, Kenneth Cummings, Peter Fegatelli, George Kleiber, Charles Larkins and Robert Smith. Larkins and Smith were the first two Indiana Rangers to die during the tour of duty.
Gary Bussell said the unit was especially close-knit because so many of its men knew each other from back home in Indiana. He said Larkins and Smith exemplified this.
“Smith and Larkins were from the same neighborhood, and they both stood up at each other’s wedding as best man,” he said. “A lot of this is for these guys. Those boys didn’t get to get past 23. I remember times back home, 20 years later, I’d be having a bad day and I just say, don’t worry about it. Larkins and Smith would’ve liked to have had your bad day 20 years later. You knew what car he drove, you knew his wife, you might know his kids’ names. And that was new to Vietnam because most fellows were put in as individual replacements.”
A break appeared to come last week, when Holland and several other Indiana Rangers were invited to the annual Congressional Picnic by Congresswoman Victoria Spartz. Holland said they were able to meet with all of the members of Indiana’s Congressional delegation, which includes one of only two remaining Vietnam War veterans in Congress, Jim Baird. They also were able to meet briefly with President Donald Trump.
During a midday meeting with several surviving Indiana Rangers, staff from Spartz’s office said they have submitted the paperwork for a valorous unit award, the military’s second-highest unit honor. After stopping by to meet with the D Company veterans, Spartz said she is pursuing both a valorous unit award and a presidential unit citation. She said she is working with the Pentagon to find out which is the most appropriate.
“I think we’re on the right track. We have a lot of good ideas of what we need to do. But I think now, we’re in the right place,” she said. “I think the paperwork needs to come from the National Guard and they will try to do, and we just got some stuff they probably need. And they’ll send it to the Department of War and the Pentagon, and hopefully we can get what, you know truly, this is past due.”
WEST LAFAYETTE, Ind. — A former governor of Indiana and university president will serve as the interim president of Purdue University starting in July.
Mitch Daniels was appointed as the interim president of the university during a public session of the Purdue University Board of Trustees on Monday. Daniels previously served as the 12th president of Purdue University and as the 49th governor of Indiana.
Daniels, who is the university’s president emeritus and the chair of the board of the Purdue Research Foundation, will succeed Mung Chiang in the position. Chiang will become the president of Northwestern University in Evanston in July.
“We are extremely grateful to President Emeritus Daniels for his willingness to continue his long and successful service to Purdue University in a role with which he is very familiar,” Gary Lehman, the chair of the Purdue University Board of Trustees, said in a news release from the university. “We look forward to working with Mitch and the executive team in leading Purdue to even greater heights as it continues to impact lives through its land-grant mission and the persistent pursuit of excellence in higher education.”
Officials stated that Daniels will serve as interim president until the university identifies a successor for Chiang. The release said a national search is expected to be launched in the coming weeks.
“President Chiang has led Purdue forward in a host of important ways, and it’s essential that the momentum he has generated be maintained,” Daniels said. “If the board believes that recalling me to active duty temporarily can help in this respect, no one as devoted to this institution as I am could say anything but yes.”
Daniels’ appointment will be effective on July 1, according to university officials.
INDIANAPOLIS (WISH) — Felix Rosenqvist won the 110th Running of the Indianapolis 500. Rosenqvist passed David Malukas on the final straightaway to win his first career Indianapolis 500.
After the narrow win, Rosenqvist described the out-of-body experience it was to win the Indianapolis 500 in front of over 350,000 people.
“I’m still not able to take it in,” Rosenqvist said. “I need another month or week. It’s been such a crazy month for me. That finish, man, I can’t get over that finish. It’s so unbelievable how close it was, I feel like any of the four of us could’ve won it. It just worked out perfectly.”
This year’s Indy 500 ended on a one-lap restart. The green flag waved on lap 199, and chaos ensued for the final 2.5-mile sprint.
Marcus Armstrong opened the final lap with the lead before David Malukas passed Armstrong coming out of Turn 1. As they headed to Turn 4, Rosenqvist made his move and passed Malukas on the final straight away to mark the closest finish in Indianapolis 500 history. Rosenqvist beat Malukas to the finish line by a mere 0.023 seconds.
Rosenqvist shared how much of a whirlwind the final lap was for him.
“That last lap, I just stayed flat on the outside, and I was like, at this point, I’m just going to go all in,” Rosenqvist said. “It just worked out, I had a little tow off with Dave in the last corner, and it’s enough to take me over the line. It was pretty gnarly. I’ve never tried it around here, but I did, and it worked for the whole lap. I just hung around the outside flat.”
Rosenqvist added more on how exhilarating the last lap felt.
“I think, honestly, if I replayed it a million times, it wouldn’t have ended up the same,” Rosenqvist said. “Everything was just 10 out of 10, and it’s no better feeling to win this race, like that, during a month where I had a baby sixteen days ago. Incredible.”
This year’s Indianapolis 500 had the most lead changes in the race’s 110-year history, with 70.
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