The United Health Foundation’s annual state health rankings found Indiana to be the 10th worst in the country, waning three positions from last year. Rates of smoking, obesity, chronic diseases, infant mortality, drug deaths, cancer, and premature deaths are among the worst in the country.
Indiana has one of the highest shortages of primary care physicians, dentists, and mental health providers. Tellingly, Indiana ranked 48th lowest in public health funding. Our poor Hoosier health is reflective of terrible lifestyle choices and lack of value placed on health by our policymakers. Indiana’s unhealthy reputation continues.
How did the General Assembly perform this session in addressing our poor health status? Here is a brief overview:
Tobacco bills did not see passage again this year. These included increasing taxes on cigarettes, taxing e-cigarette liquids and increasing the legal age to 21. Disappointing but certainly not surprising.
All marijuana bills never saw the light of day. Although the majority of states, including surrounding states, have enacted cannabis-related legislation, Indiana legislators remain firmly opposed. Don’t expect any movement on medical marijuana anytime soon.
The enacted budget bill addresses physician shortages by increasing funding for medical student primary care scholarships, maintaining supplemental funding for family medicine residencies, and allocating development funding for new and expanded residency programs, mostly primary care. The budget bill also funds two excellent programs addressing infant mortality in at-risk women — the OB Nurse Navigators Program and the Nurse Family Partnership.
SB 394 was an extremely contentious bill that would have allowed advanced practice registered nurses (nurse practitioners) to practice and prescribe independently in Indiana. The medical community strongly opposed this legislation on the basis that APRNs simply do not have the clinical training to do so with only about 750 hours of clinical experience before graduation. The legislation did not require any true additional post-graduate clinical physician-collaborative educational training. The bill was steamrolling to passage until Representatives Brad Barrett and Rita Fleming, both physicians, boldly challenged the bill. Legislators finally listened to reason and it died for lack of support. Thank goodness.
SB 141 creates regulations for office-based buprenorphine prescribing for opioid addiction, assuring responsible and appropriate prescribing and treatment, yet not discouraging providers (through onerous provisions) from treating their patients. HB 1007 requires obstetrical-care providers to assess for substance-use disorders in pregnancy and appropriately provide or refer for treatment.
HB 1547 ensures that girls 16 and older will be able to make health care decisions regarding pregnancy, labor and delivery and post-partum care if the parents are unavailable or uninvolved. Currently, teenagers can make decisions regarding the baby but not themselves. A much-needed rational change.
SB 201 extends the list of providers who may opt-out of participating in pregnancy terminations, either by medications or surgical procedures, to physician assistants, nurses and pharmacists. One ought to be able to follow one’s conscience, but it should have included the requirement to refer to a willing provider to assure continuity of care.
HB 1211 makes “dismemberment” second trimester pregnancy terminations illegal in Indiana unless the pregnancy is a serious threat to the health or life of the mother. The exceptions should have included fatal-fetal conditions. Although second trimester abortions are rare in Indiana, this procedure is the most common and felt to be the safest method. The ACLU has already filed suit.
Although there were some encouraging measures passed this year and some bills that were fortunately defeated, there were bills that missed the target and lost opportunities to enact much needed health-related legislation. We should do better.
Richard Feldman, M.D., is an Indianapolis family physician and the former Indiana State Health commissioner.
