Indiana legislators have put forth a host of bills they hope will curb high health care costs for Hoosiers. (Getty Images)
I don’t feel bad for lawmakers very often. But trying to solve the national problem of high health care costs and accessibility from a state-level perspective is rough. And almost impossible.
The best they can hope for is less of an annual increase, which is honestly downright depressing.
The first issue is identifying the problem. In many situations, you can easily find the villain in a story and focus on getting justice that way. But the health care system is so complicated that there are a lot of villains.
Hospitals. Insurance companies. Pharmacy middlemen. Drug manufacturers.
Whenever there is a hearing on these topics, these stakeholders point at each other like that Spider-Man meme. The fact is all of them are responsible, in part, for a system that focuses more on money than patients.
Indiana legislators, bless their hearts, have been trying to address that problem for years. They have created a database where Hoosiers can see the costs of procedures and shop around key health care needs. They have stepped up oversight on mergers and monopolies. They have limited “surprise” billing for emergency out-of-network services.
And yet, there are still 450,700 uninsured Hoosiers. That’s 6.8% of the state’s population, according to KFF. About 600,000, or 12%, of adults in Indiana reported having medical debt in a given year from 2019 and 2021. The U.S. average of people reporting medical debt is 8.6%.
To make any real progress, lawmakers are going to have to become more prescriptive — which isn’t easy for the GOP supermajorities who otherwise believe in letting capitalism work without government intervention..
Promising efforts
To start with, I’m heartened by an effort to clamp down on the billions in assets that nonprofit hospitals have. Republican Fort Wayne Rep. Martin Carbaugh wants to take away the nonprofit status if hospitals are charging exorbitant prices.
Another promising bill is about prior authorization. We’ve all been there. You go to your doctor, who has treated you for years and knows your personal situation. They order a test, and the insurance company comes back and says you can’t have the test. They know better — or at least their algorithm does. Theoretically, prior authorization might save money. But it also endangers patients and second guesses doctors. A bill by GOP Sen. Tyler Johnson — a doctor himself — would severely limit how often doctor’s orders can be blocked.
Another reason hospital prices are so high is site of service. Companies have bought up doctor’s offices, hospitals, imaging centers and other health care facilities and treat them all as hospitals, regardless of where they are physically located. That allows them to charge a higher rate. This change would cost hospitals tens of millions, and they have fought it for years.
And let’s not forget about drug prices. Transparency isn’t working, so it might be time for hard caps on certain life-saving medications. Insulin is the obvious one, but there are lots more. An EpiPen that can stop fatal allergic reactions is another example. Heck, my dad has an inhaler that costs $800 a month. It helps him breathe, and he spent weeks last year trying to find a way to get the cost covered. Meanwhile, drug companies and pharmacy benefit managers — the middlemen between pharmacies and drug manufacturers — are reaping obscene profits. This is another opportunity for helping Hoosiers.
Several of these bills are already moving this session, and I hope you share the same optimism I have.
I don’t know if any of these changes would mean a cut in health care costs, but I do know it would show that my representatives care enough to try new things — even things they might traditionally not be comfortable with — because what we have isn’t working.
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