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HIP faces deep cuts as Republicans hide behind Medicaid’s complexity | Opinion

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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.

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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.”

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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

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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.

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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.



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Indiana’s Curt Cignetti Wins Coach of the Year Award for 2nd Straight Season

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Indiana’s Curt Cignetti Wins Coach of the Year Award for 2nd Straight Season


For the second consecutive season, Indiana head coach Curt Cignetti has been named college football’s Coach of the Year following a magical 2025 campaign.

Cignetti, who joined Indiana last November, won the Home Depot Coach of the Year Award on Friday night, making him the first coach to win the award in back-to-back seasons. He is also just the second coach to win the honor twice, joining Brian Kelly, who won it in 2009, 2012 and 2018.

Cignetti’s Hoosiers delivered an encore worthy of recognition following his successful first year in Bloomington where they fell in the first round of the College Football Playoff after going 11-2 overall and 8-1 in the Big Ten. Unlike 2024, however, the 2025 season will go down as the best in program history with Cignetti and California transfer quarterback Fernando Mendoza leading the way.

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Indiana went undefeated (13-0) for the first time since 1945 and won its first outright Big Ten championship since 1967 with a win over Ohio State en route to clinching the No. 1 seed in the CFP for the first time. The Hoosiers enter the CFP as the favorites to win their first-ever national title.

While Indiana was one of CFB’s most well-rounded teams, Mendoza proved to be a major catalyst behind the success. In his first season with Cignetti, the redshirt junior earned the right to call himself a Heisman Trophy favorite after leading the nation with 33 touchdown passes to just six interceptions, and completing 71.5% of his passes (226-of-316).

Mendoza has won multiple awards, including the Davey O’Brien (top QB) and Maxwell (Player of the Year) Awards, entering Saturday’s Heisman Trophy ceremony. Should he win the coveted honor, Mendoza would be the first Hoosier to ever win the Heisman, giving Cignetti another feather in his cap as top-seeded Indiana looks to make CFP history, starting with its first-round game on Jan. 1.

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Indiana’s rejection of new voting map shows Trump’s might is not unlimited

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Indiana’s rejection of new voting map shows Trump’s might is not unlimited


The Indiana legislature’s rejection of a new map that would have added two Republican seats in Congress marked one of the biggest political defeats for Donald Trump so far in his second term and significantly damaged the Republican effort to reconfigure congressional districts ahead of next year’s midterm elections.

The defeat showed that Trump’s political might is not unlimited. For months, the president waged an aggressive effort to twist the arms of Indiana lawmakers into supporting a new congressional map, sending JD Vance to meet in person with lawmakers. Trump allies also set up outside groups to pressure state lawmakers.

Heritage Action, the political arm of the Heritage Foundation, which has close ties to the Trump administration, issued a dramatic threat this week ahead of the vote: if the new map wasn’t passed, Indiana would lose federal funding. “Roads will not be paved. Guard bases will close. Major projects will stop. These are the stakes and every NO vote will be to blame,” the group posted on X. The state’s Republican lieutenant governor said in a since-deleted X post that Trump administration officials made the same threat.

All of that may have backfired, as Republican state senators publicly said they were turned off by the threats and weathered death threats and swatting attempts as they voted the bill down.

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“You wouldn’t change minds by being mean. And the efforts were mean-spirited from the get-go,” Jean Leising, an Indiana Republican state senator who voted against the bill, told CNN. “If you were wanting to change votes, you would probably try to explain why we should be doing this, in a positive way. That never happened, so, you know, I think they get what they get.”

Nationally, the defeat complicates the picture for Republicans as they seek to redraw districts to shore up their majority in an increasingly messy redistricting battle. The effort began earlier this year when Trump pushed Texas Republicans to redraw the state’s congressional map to pick up GOP seats, a highly unusual move since redistricting is usually done once at the start of the decade.

“This isn’t the first time a Republican state legislature has resisted pressure from the White House, but it is the most significant, both because of the over-the-top tactics President Trump and speaker Johnson employed, and also the fact that there were two seats on the line,” said Dave Wasserman, an expert in US House races who writes for the non-partisan Cook Political Report. “It changes the trajectory of this redistricting war from the midpoint of possible outcomes being a small, being a modest Republican gain to a wash.”

Republicans in Texas and Democrats in California have both redrawn their maps to add as many as five seats for their respective parties, cancelling each other out. Republicans in North Carolina and Missouri have also redrawn their congressional districts to add one Republican seat apiece in each of those states. The Missouri map, however, may be blocked by a voter initiated referendum (Republicans are maneuvering to undercut the initiative). Democrats are also poised to pick up a seat in Utah after a court ruling there (state lawmakers are seeking a way around the ruling).

Ohio also adopted a new map that made one Democratic district more competitive, and made a new Democratic friendly and Republican friendly district out of two different competitive districts.

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The biggest remaining opportunity to pick up seats for Democrats is in Virginia, where they currently represent six of the state’s 11 congressional districts. Don Scott, the House speaker, has said Democrats are considering adding a map that adds four Democratic seats in the state. Republicans could counter that in Florida with a new congressional map that could add as many as five Republican seats. There is also pending litigation challenging a favorable GOP congressional map in Wisconsin.

The close tit-for-tat has placed even more significance on a supreme court case from Louisiana that could wind up gutting a key provision in the Voting Rights Act that prevents lawmakers from drawing districts that weaken the influence of Black voters. After oral argument, the court appeared poised to significantly curtail the measure, which could pave the way for Louisiana, Alabama, and other southern states to wipe out districts currently represented by Democrats. It’s unclear if the supreme court will issue its decision in time for the midterm elections.

“The timing of that decision is a huge deal with two to four seats on the line,” Wasserman said. “We haven’t seen the last plot twist in this redistricting war, but the outlook is less rosy for Republicans than it was at the start.”



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Indiana redistricting: Senate Republicans side with Democrats to reject Trump’s voting map

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Indiana redistricting: Senate Republicans side with Democrats to reject Trump’s voting map


Indiana Republicans have defied intense pressure from President Donald Trump by rejecting his demands that they pass a voting map meant to favour their party in next year’s midterm elections.

In one of the most conservative states in the US, 21 Republicans in the Senate joined all 10 Democrats to torpedo the redistricting plan by a vote of 31-19. The new map passed the House last week.

If it had cleared the legislature, Republicans could have flipped the only two Democratic-held congressional seats in the state.

Trump’s call for Republican state leaders to redraw maps and help the party keep its congressional majority in Washington next year has triggered gerrymandering battles nationwide.

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Republican-led Texas and Democratic-led California, two of the country’s largest states, have led the charge.

Other states where redistricting efforts have been initiated or passed include Utah, Ohio, New Hampshire, Missouri and Illinois.

Republican state Senator Spencer Deery said ahead of Thursday’s vote: “My opposition to mid-cycle gerrymandering is not in contrast to my conservative principles, my opposition is driven by them.

“As long as I have breath, I will use my voice to resist a federal government that attempts to bully, direct, and control this state or any state. Giving the federal government more power is not conservative.”

Indiana Governor Mike Braun, a Republican, said he was “very disappointed” in the outcome.

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“I will be working with the President to challenge these people who do not represent the best interests of Hoosiers,” he said on X, using a popular nickname for people from the Midwestern state.

The revolt of Indiana Republicans came after direct months of lobbying from the White House.

On Wednesday, Trump warned on his social media platform Truth Social that Republicans who did not support the initiative could risk losing their seats.

He directly addressed the Republican leader of the state Senate, Rodric Bray, calling him “the only person in the United States of America who is against Republicans picking up extra seats”.

To liberals, it was a moment of celebration. Keith “Wildstyle” Paschall described the mood on Thursday as “jubilant”.

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“There’s a lot of relief,” the Indianapolis-based activist told the BBC. “People had thought that we would have to move on to a legal strategy and didn’t believe we could defeat it directly at the statehouse.”

The new map would have redistricted parts of Indianapolis and potentially led to the ouster of Indiana’s lone black House representative, André Carson.

In the weeks before Thursday’s vote, Trump hosted Indiana lawmakers at the White House to win over holdouts.

He also dispatched Vice-President JD Vance down to Indiana twice to shore up support.

Nearly a dozen Indiana Republican lawmakers have said they were targeted with death threats and swatting attacks over the planned vote.

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Ultimately, this redistricting plan fell flat in another setback for Trump following a string of recent Democratic wins in off-year elections.

The defeat appears to have added to Republican concerns.

“We have a huge problem,” said former White House chief strategist Steve Bannon during his podcast, The War Room.

“People have to realise that we only have a couple opportunities,” he said.

“If we don’t get a net 10 pickup in the redistricting wars, it’s going to be enormously hard, if not impossible, to hold the House.”

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Texas was the first state to respond to Trump’s redistricting request.

After a lower court blocked the maps for being drawn illegally based on race, the Supreme Court allowed Texas Republicans to go ahead.

The decision was a major win for Republicans, with the new maps expected to add five seats in their favour.

California’s map is also expected to add five seats for Democrats.



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