Sen. Liz Brown, R-Fort Wayne, asks a fellow committee member a question on March 11, 2025. (Whitney Downard/Indiana Capital Chronicle)
A universally adopted funding program to boost local public health departments is facing a tough budget road, with some lawmakers questioning whether agencies have delivered on their promises or should be further constrained.
The two-year-old Health First Indiana program allocated $225 million to local public health departments in the last budget cycle, or $75 million in 2023 followed by $150 million in 2024. The latest version of the budget earmarks $100 million each year.
But following a budget presentation before the Senate Appropriations Committee on Thursday, Sen. Liz Brown suggested local public health departments would simply continue to move the goalposts when it came to meeting their goals.
We talk all the time about moving decisions down to the lowest level. Well, we moved this down to the lowest level and now we want to start nitpicking what some of them have chosen. That’s not right.
– GOP Sen. Ed Charbonneau
“When this was proposed to us, we were going to see more immediate results and … these are all promises. We’re not seeing significant results yet and yet we’re doubling down,” said Brown, R-Fort Wayne.
Committee Chair Sen. Ryan Mishler said he and other members had received pressure from their communities to cut or eliminate the program due to questions about the money’s uses.
One particular concern forwarded to the Mishawaka Republican was about an unnamed county using money to provide health care services for undocumented immigrants, which he acknowledged was “a very sensitive issue.”
“We (said) the locals can make their decisions, but it’s still state money. And how can you allow state money to be used?” Mishler told the Indiana Capital Chronicle. “We tried to get flexibility, that’s what (local public health departments) wanted, but then people still come back to us because it’s state money.”
Mishler declined to share other examples of concerns.
“I don’t want to sit here and say that we’re going to eliminate it or we’re going to cut it. I don’t know what’s going to happen there,” Mishler told his fellow committee members. “But you may at least see some restrictions on the uses as a happy medium.”
A desire for results
State Health Commissioner Lindsay Weaver cited research about the return on investment for public health dollars, which can be up to $14.30 for every $1 spent. She pointed to the program as a way to reduce health care utilization and Medicaid expenditures “by getting in front of” these issues.
Additionally, she said local economic development organizations reported that people moving into their areas “are looking at those health metrics,” which are posted on the state site.
“This is the program that’s going to make a difference in that space,” she said.
One area she pointed to was birth outcomes. Indiana has some of the worst infant and maternal mortality rates in the country but, prior to this funding, only 39% of counties had an evidence-based program to improve.
Now, Weaver said, 84% did.
“I do fully suspect we’ll be at 100% by the end of 2025,” she said.
Brown acknowledged that it took time for the money to be distributed to departments, which then partnered with local organizations to deliver services like prenatal health services and diabetes management.
But Brown pointed to smoking cessation as a concern, noting that such information depended on “imperfect” survey data.
“I could start with 25% of my county smoking and as the smokers age out (and) die from lung cancer or heart disease, I may not have new smokers. So I have a lower smoking rate in my county but I haven’t actually reduced the smoking rate in my county at all,” she said.
Weaver noted that such efforts also included vaping, which is disproportionately popular among Hoosier youth.
Many counties have devoted money to smoking cessation programs, as detailed on the state website. However, the state doesn’t have an aggregate report on its website.
Sen. Mike Crider, R-Greenfield, pointed to the oft-debated tobacco tax increase as one way to reduce cigarette use and, by extension, Medicaid costs.
“I, for one, am going to be encouraging us to continue to play the long game,” said Crider, who called himself a fan of the program. “Because this isn’t a short game; we’re not going to change behavior overnight.”
One Democrat likened program spending to “deferred maintenance.” Prior to the program, counties spent an average of $55 per resident for public health — far below the national average of $91 — though totals ranged from $83 to $1.25 per Hoosier, depending on their county of residence.
“On one hand, we don’t want to spend on Medicaid. But, on the other hand, we don’t want to improve public health. You can’t have it both ways,” said Sen. Fady Qaddoura, D-Indianapolis. “… You’re not paving roads, you’re dealing with the human condition. And that can’t be dealt with quickly.”
In defense of Health First Indiana
Brown floated the possibility of restricting the fund uses to exclude regulations — such as inspecting tattoo parlors or mitigating lead poisoning — and capital improvements. Currently law restricts regulatory spending to less than 40% and capital to less than 10%.
But Sen. Ed Charbonneau, who authored the 2023 bill that created Health First Indiana, defended the program before his fellow committee members.
“This isn’t like an economic development program where you fund something with $250 million dollars and two years later you’ve got a building up and 50 people working,” said Charbonneau, R-Valparaiso. “We knew, at the beginning, this was going to be a long-term approach.”
He said Thursday was the first time he’d heard there’d been a promise for “immediate results.”
“If that was the case, it wasn’t true. Because there’s no way that this program was going to be able to create immediate results,” said Charbonneau.
Even before it got off of the ground, it faced pushback. Dozens of Hoosiers criticized any investment in public health as the COVID-19 pandemic wound down. To address those concerns, the bill was crafted in a way that gave control to counties.
The program is arguably the biggest accomplishment of former Gov. Eric Holcomb’s time in office.
“We talk all the time about moving decisions down to the lowest level. Well, we moved this down to the lowest level and now we want to start nitpicking what some of them have chosen. That’s not right,” Charbonneau said. “… with this kind of program we ought to be proud.
“Those results are going to come somewhere down the road,” he continued.
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