The 2023 Indiana General Assembly, which closed on April 28, saw some significant progress in health-related legislation, but also some disappointments.
This is my take from the perspective of a family physician and former public health official.
Indiana remains one of the unhealthiest states in the state, with public health funding near the bottom. An unfortunate Hoosier tradition.
Senate Bill 4 is a landmark piece of legislation that invests $225 million over two years in providing infrastructure and health programs for local health departments. Much more needs to be done. Speaking of which, Congress wasn’t seriously considering raising tobacco taxes.
SB7 prohibits non-compete clauses in employment contracts with primary care physicians (family physicians, general pediatricians, internal medicine). It is believed that the ban will increase competition, reduce health care costs, establish greater medical freedom, and preserve patient access and continuity of care.
Other professionals benefit from certain situations where non-compete clauses are unenforceable and from the process of contract acquisition mediation.
Controversially, Indiana’s hospital rates are among the highest in the nation. HB1004 enhances the process of hospital financial data collection and state reporting.
New abortion laws make preventing unwanted/unplanned pregnancies more important than ever. HB1568 increases access by allowing pharmacists to safely prescribe self-administered hormonal contraceptives in the form of tablets, patches and rings (as permitted in her other 24 states).
There are many safeguards in place, including patient screening tools, pharmacist training, referrals to primary care providers, and further rule-making with input from medical professionals. Also, the duration of her prescription is limited to 6 months, and the patient must see a doctor within her 12 months.
State budget bill HB1001 keeps Medicare rates reimbursed for providers of Medicaid and Healthy Indiana plans. This helps ensure that patients have access to their healthcare providers. HB1001 also increases state funding for expansion of Indiana’s training programs and support for maintaining quality family medicine training. Indiana has one of the worst doctor shortages in the country.
SB275 is added to the designated list of specialties that should be restricted to physicians, such as “pulmonologist”, “allergist”, and “neonatologist”.
Unfortunately, the badge requirements, including license types such as doctors, nurses, and physician assistants, were amended from the bill. Patients continue to be confused about exactly who provided their care in the clinical setting. More clarity and transparency is needed to clearly disclose the types of health professionals.
If several bills failed to pass, advanced practice registered nurses (nursing practitioners) with prescribing authority were supposed to be able to practice independently without a physician partnership agreement.
These were strongly opposed by the medical community, apparently based on quality of care concerns. Nursing practitioners are valuable medical professionals, but they are not physicians and must be part of a physician-led team.
SB480 was a controversial bill that would prohibit gender reassignment care for minors through medication or surgery, even with parental consent. The nation’s health system is adamant in its support of this treatment, which has been proven to maintain mental health and prevent suicide.
Shouldn’t these decisions be left to family and doctors without interference? So much conservative belief in small, unintrusive government.
Only one of the 13 cannabis bills received a public hearing. The decriminalization bill was considered in committee without a vote. This was historic in that it was the first time marijuana was discussed in the Indiana Legislature. No doubt there will be more to come.
Overall, this was a good session for healthcare.
Richard Feldman He is a family physician in Indianapolis and served on the Indiana State Health Commissioner from 1997-2001 under Governor Frank O’Bannon. He writes monthly about the serious health issues facing the Hoosiers. Emails can be sent to richarddfeldman@gmail.com.