Republican gubernatorial candidate Mike Braun on Thursday provided an advance copy to the Indiana Capital Chronicle as he unveiled a six-pronged health care plan outlining the sitting senator’s priorities for Indiana, many of which are expansions of previous state legislative proposals.
In contrast to Gov. Eric Holcomb, who has largely stayed away from ongoing legislative negotiations, Gov. Brown has placed his finger firmly on the scales to favor one view over another in several contentious ongoing debates on issues ranging from regulating pharmacy benefit managers to banning non-compete clauses for health care providers.
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The politician has leaned heavily on his health care expertise throughout the campaign to replace the term-limited Holcomb, repeatedly highlighting his experience as owner of Meijer Distributing Co. in southern Indiana and his work at the federal level.
“As a Main Street entrepreneur who has dealt with the rising cost of health care in my own business, I know firsthand that high health care costs are a glaring weakness in attracting new businesses and new residents, and a burden on hardworking Indiana residents and business owners,” Brown said in a statement. “The solutions are low-hanging fruit: transparency, innovation, competition and empowering consumers, and I will provide the leadership needed to deliver solutions that lower health care costs for Indiana residents.”
The plan’s six pillars — quality, cost, transparency, access, health and competition — clearly build on the work of the General Assembly, which, according to an accompanying white paper, “laid a solid foundation for more ambitious efforts.”
Like previous proposals, Brown’s plan is backed by research from conservative Hoosiers for Opportunity, Prosperity & Enterprise (HOPE), the nonprofit arm of the Terre Haute-based campaign.
The plan does not include any fiscal analysis and would need support from lawmakers who have failed to pass similar proposals. Brown faces Democrat Jennifer McCormick and Libertarian Rep. Donald Rainwater in the general election. The deadline to register to vote is October 7.
Intervening in ongoing state legislative debate
The HOPE document begins by characterizing the state’s health care costs as “robbing Indianans of their paychecks” through “rising insurance premiums, more expensive prescription drugs and ballooning hospital bills.”
Earlier this year, the National Conference on Healthcare Cost Transparency, shortly before honoring Brown for his work on the federal health care bill, released a study finding that Indiana’s hospital costs were the eighth-highest in the nation. One of the groups behind the conference, the Indiana Employers Forum, has been a vocal critic of hospitals at the state level and has pushed for several bills to rein in high costs through additional hospital regulations.
Notably, at least one major hospital CEO supported Brown’s opponent in the Republican primary and encouraged his colleagues to do the same.
HOPE’s white paper expands on this employer perspective, adding that “rising health care costs not only put a strain on families, but also on employers considering relocating to the state or expanding their footprint.”
Excerpted from Mike Brown’s Healthcare Proposal, prepared by HOPE, Inc.
“While Indiana’s business-friendly tax environment gives it an advantage over other states, the state is equally or more disadvantaged by high health care costs,” the paper noted.
Brown will push for more data sharing during insurance negotiations and “ensure that employers and other group health plan sponsors have the ability to access, audit and review claims data.”
Insurance companies have resisted sharing the information, claiming it is a “trade secret.”
The plan echoes heated debates from past legislative sessions, including banning non-compete clauses at non-profit hospitals, though the Federal Trade Commission has already tried to ban non-compete agreements at the for-profit hospital level and is currently facing a legal challenge. A previous proposal to ban non-compete agreements in the health care sector faced opposition and was ultimately limited to primary care physicians.
The document proposed increased regulation of pharmacy benefit managers, who negotiate drug prices between drug manufacturers, insurers and distributors such as pharmacies.
“In reality, these middlemen between pharmacies and drug companies simply drive up the cost of prescription drugs,” the paper said, echoing the position of the Federal Trade Commission, which recently announced it would take legal action against the nation’s three largest PBMs.
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But lawmakers have struggled to take action against PBMs to limit kickback spending, instead requiring the groups to register with states and directing insurance departments to collect claims data.
Additionally, efforts to reform prior authorization at the state level have repeatedly hit roadblocks, but Brown advocates barring insurers from revoking prior authorizations and requiring that denials be made by medical professionals who are “similarly qualified as the physician applying.”
Other long-pending issues, including faster physician certification, mutual recognition of medical licenses, location-independent pricing and credits in reimbursement agreements, have also become priorities for lawmakers who have faced lobbying opposition in the state Legislature.
The plan requires the Indiana Graduate Medical Education Fund to prioritize rural training of obstetricians to fill coverage gaps, among other provisions aimed at alleviating the ongoing physician shortage. Repeated public hearings have concluded that monopolies and consolidation drive up health care costs in Indiana, and Brown proposes combating this by encouraging new primary care facilities through a revolving fund under the Indiana Department of Finance. The fund would be established “utilizing Indiana Economic Development Corporation funds,” but the process was not immediately clear.
Other pro-competitive principles include strengthening state antitrust laws and requiring attorney general approval for “all private equity mergers and acquisitions in the health care industry.” It would also allow the attorney general’s office to block certain merger actions. Currently, the attorney general’s office can only investigate and request information about consolidations in deals over $10 million.
Medicaid Regulations
Brown’s plan includes requiring Medicaid enrollees to consult with their primary care physician before non-emergency visits to emergency rooms, which are among the most expensive forms of health care, and encouraging private health insurers to do the same.
This also requires improving Medicaid enrollees’ access to primary care physicians. Low reimbursement rates mean fewer doctors participate in Medicaid. To reverse this situation, “states should provide Medicaid patients access to program funds that support direct primary care relationships,” the paper concludes.
These efforts will be accompanied by health literacy materials emphasizing the importance of primary care for Medicaid recipients, as well as the general public.
Reducing state and federal costs for Medicaid will be a key discussion in the 2025 budget session, when lawmakers must draft a long-term funding plan for the entitlement program that is the fastest-growing part of the state budget.
Other Medicaid provisions across several pillars of the plan include:
Allowing Medicaid to reimburse providers for continuity of care services across separate facilities Setting out “clear metrics to evaluate quality of care and patient outcomes” under PathWays for Aging, a managed care program that launched in July Strengthening transparency and accountability protections Independent audits of Medicaid claims (as well as audits of claims under the State Employees Health Insurance Plan) Expanding telehealth for Medicaid enrollees
Finally, Brown is seeking to authorize the Attorney General’s Medicaid Fraud Unit to work with the Department of Family and Human Services to investigate overpayments, duplicate claims and other suspicious Medicaid claims. This comes on the heels of a whistleblower lawsuit alleging the department overlooked $700 million in misuse of funds.
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