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Thousands of Hoosiers will soon lose Medicaid access, but the cost of the program is still increasing
(Design: Brittney Phan for State Affairs)
Key Points
- A net 400,000 Hoosiers are expected to lose Medicaid access over the next year due to the end of a pandemic-era policy.
- In the first month of the policy change, a majority of those who lost access to Medicaid did so for procedural reasons, not because they were found ineligible. That signals a problem.
- Despite the expected decline in enrollees, Indiana’s Medicaid general fund budget increased by almost 40% in the two-year budget.
Hundreds of thousands of Hoosiers are poised to lose Medicaid insurance access over the next year due to the end of a COVID-19 pandemic-era federal policy that prevented states from kicking people off Medicaid.
Despite that, state costs for the health program serving more than 2.2 million low-income Hoosiers, including more than 60% of Indiana’s children, are only expected to continue to grow over the next two years. That puts pressure on the system and the state’s budget.
Indiana spends billions of dollars on Medicaid each year, making it the second largest expense to the state’s general fund following K-12 education.
In the last decade, Medicaid assistance has doubled, growing at a faster pace than the state’s general fund budget as a whole. It now makes up nearly 18% of the general fund budget, which means less money for other priorities such as education, paying down state debt or infrastructure.
“If you ask me what I lay awake at night thinking about,” Senate President Pro Tempore Rodric Bray, R-Martinsville, said at the end of the legislative session, “it’s Medicaid spending.”
The increased pot of money needed for Medicaid makes it challenging for advocates of either expanded access or increased Medicaid reimbursement rates to make their case. It also means some Hoosiers, such as those who rely on Medicaid for autism services, fear cuts may be coming.
Why so many Hoosiers will likely lose access to Medicaid
Over the next year, the state estimates that a net 400,000 Hoosiers, or nearly one-fifth of the number currently on Medicaid, will lose their Medicaid insurance access.
During the pandemic, the federal government prevented states from disenrolling people from Medicaid even if they were no longer eligible, in exchange for more federal dollars. That caused the number of people on Medicaid in Indiana to increase by more than 800,000 enrollees over the three-year period.
The Biden administration prohibition ended at the end of March, which means that for the next year, the state of Indiana will start double-checking whether those receiving Medicaid still qualify, in a process known as unwinding.
Advocates are worried some people will be kicked off by accident, or won’t realize they lost insurance until it’s too late and they’re hit with a doctor's bill. The Family and Social Services Administration (FSSA) is sending people at risk of losing access a notice, but Adam Mueller, executive director of the Indiana Justice Project, and other advocates say it’s possible people either won’t get the notice or won’t understand its importance.
“Our biggest concern is that folks who should still be eligible for Medicaid or HIP [Healthy Indiana Plan] or any of the programs could lose coverage for procedural or administrative reasons,” Mueller said. “Even where there’s not a giant unwinding going on, people slip through the cracks.”
To that point, a recent report from the state found that of the roughly 52,000 people who lost coverage in the first month, more than 88% of them lost their Medicaid simply due to procedural reasons such as failing to respond to FSSA, not because the state found them ineligible. That could signal a problem in how Indiana is unwinding, said Joan Alker, executive director and co-founder of the Center for Children and Families at Georgetown University.
“When you see a lot of procedural losses, there’s probably a lot of people, particularly children, who remain eligible, but they’re getting terminated anyways,” Alker said. “Is the state making clear that the children and the parents may have different outcomes, that like the parent is losing [Medicaid access, but] the child is still eligible?”
Advocates also fear that those who do lose access because they are no longer eligible won’t know where to find low-cost insurance options and will go uninsured instead.
So why are the costs still ballooning?
With a net decrease in Medicaid enrollees on its way, it seems counterintuitive that the costs for the program to the state would increase, so why is Indiana’s Medicaid general fund spending poised to increase by almost 40% from the previous budget?
It’s partially because the process of double-checking Medicaid eligibility will take 12 months, which means Indiana will continue to feel the effects of the pandemic requirement until May of next year. Meanwhile, the extra funding from the federal government, which typically covered the extra costs of continuous enrollment to the states, will be phased out by the end of 2023.
“There’s been some inaccurate rhetoric and claims flying around that states have been forced to carry this population, that it’s been very burdensome on them,” Alker said. “That wasn’t true because the federal government was giving them extra money.”
But even if the pandemic requirement had not been a factor, Indiana’s Medicaid costs would likely have increased due to the growth in those enrolling, and are poised to continue increasing in the future. Michele Holtkamp, a spokeswoman for FSSA, said that’s being driven largely by an increase in the number of seniors in Indiana, who often require more costly care.
Hoosiers aged 65 years and older are making up a growing share of the population, and that trend isn’t expected to slow down in the coming years. By 2030, 1 in 5 Hoosiers will be senior citizens, according to a 2018 report from the Indiana Business Research Center.
“That’s just something we and every other state in the country will have to deal with,” Allison Taylor, interim Medicaid director for FSSA, said during an April Medicaid forecast presentation.
Likewise, the state is spending more on behavioral health costs for children. There’s currently no uniform reimbursement rate for Applied Behavior Analysis therapy, commonly used to help children with autism, which means reimbursement amounts are often significantly higher than in other states, Holtkamp said. In 2022, the state spent $420 million on such services, which she called “not sustainable.”
Indiana has also expanded Medicaid in other ways. For example, a new federal rule will require states to provide 12 months of continuous coverage for children enrolled in Medicaid. That protects children from going off and on Medicaid due to minor changes in their parents’ income or other “red tape losses,” but once again, there is a cost. Indiana also extended postpartum eligibility.
The most recent data available from Kaiser Family Foundation puts Indiana near the middle of the pack when it comes to per-enrollee spending for Medicaid and 39th when comparing how much of the general fund is made up of Medicaid spending. But without more recent data, it’s challenging to know how Indiana compares today to other states.
What’s the solution?
Finding a way to stop costs from increasing is complicated because, typically, activists and lawmakers are pushing for an increase in Medicaid access or reimbursement rates — both of which might help Hoosiers but could drive up costs more. Already, Indiana requires those making over a certain income level to make a monthly contribution to their health care.
Some lawmakers pointed to one solution: fix Hoosiers’ dismal health outcomes in hopes that it will reduce the need for care among those using Medicaid. Valparaiso Republican Sen. Ed Charbonneau, who championed a revamp of the public health system in Senate Bill 4, hopes his bill will help.
“This may be a way to bend the curve just a little bit, because unless we prevent people from getting sick … it’s going to get worse,” Charbonneau said. “We can’t keep it up.”
Beyond that, Indiana could strengthen eligibility requirements or lower Medicaid reimbursement rates, both of which would likely be unpopular.
Starting this year, FSSA is undergoing regular Medicaid reimbursement rate reviews. That means costs to the state could go up or down depending on what rates the agency lands on.
Could those reviews cause problems?
They could. This year, for example, lawmakers are coming up with a uniform reimbursement rate for Applied Behavior Analysis therapy. That means some providers could experience cuts.
Indiana ACT for Families, which aims to protect access to care for children with Autism Spectrum Disorder, actively pleaded with lawmakers and the Holcomb administration during the legislative session not to cut funding.
“The outcome of this review has existential repercussions for the children we serve,” the organization wrote in an April letter to lawmakers. “A sudden and steep funding cut would make it extremely difficult for some providers to continue operations and would reduce availability of quality ABA therapy that is critical to the children and families that we serve.
Meanwhile, other Medicaid recipients spent the legislative session pleading with lawmakers to increase reimbursement rates. The Indiana Hospital Association, for example, said Indiana’s current rate only covers about 53% of costs.
What’s next
Indiana is poised to share the first batch of proposed Medicaid reimbursement rates within the next few weeks, Holtkamp said. The state will look at others, such as hospital reimbursement rates, during the next budget cycle.
Aside from that, Mishawaka Republican Sen. Ryan Mishler, the chief budget architect on the Senate side, has made it clear that he wants to be very picky when it comes to legislation that would increase Medicaid costs.
“We still have a lot of bills out there where members want to keep expanding it and adding more people to the program, and that’s something we have to take a look at is how much do we really want to keep expanding? Because once we do it’s ongoing,” Mishler said during the legislative session. “We just have to figure out the growth of the Medicaid.”
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Your questions answered: Why the state is feuding with Tippecanoe County over water for the LEAP District
Editor’s note: This article is part of a State Affairs and Fox59/CBS4 series looking at how decisions get made at the Indiana Economic Development Corp. and how it impacts economic development in the state. The IEDC has faced increased scrutiny due to its involvement with Boone County’s LEAP Lebanon Innovation District and because two gubernatorial candidates are former IEDC leaders. Read our first story here.
The gist
The Indiana Economic Development Corp. is banking on the success of the LEAP Innovation and Research District, a tech hub in Boone County.
But, the state agency is missing a crucial resource it needs to enable more high-tech industries to call the hub home: enough water. The IEDC, the state agency tasked with driving economic development, hopes to funnel water from the aquifer that sits adjacent to the Wabash River in Tippecanoe County roughly 40 miles away, if studies go as planned.
Opposition to the plan has bubbled over among Tippecanoe County residents and their elected leaders, concerned about what siphoning water away from their community could mean for them long term.
What was once an often-ignored topic in Indiana has become one of the most contentious, bi-partisan issues ahead of the 2024 legislative session.
“I’ve never seen an issue like this that united everybody,” said Sen. Spencer Deery, R-West Lafayette.
Here’s what you should know about the water fight.
What is the LEAP District
The LEAP District will be a 9,000-acre “hub of global innovation” in Lebanon. The land is already ready for the IEDC’s use whenever high-tech companies show interest.
The LEAP District was created in order to allow the state to move more quickly to land deals, said Secretary of Commerce David Rosenberg. Back in 2021, the IEDC lost a bidding war against Ohio for Intel, a chip manufacturer. One reason Indiana lost, Rosenberg said, was because Indiana didn’t have readily available land for use, and wasn’t able to move as quickly as Ohio.
Indiana-based drug manufacturer Eli Lilly and Company was the first to announce it would be building two manufacturing sites in the LEAP District, investing $3.7 billion and creating up to 700 jobs. Indiana is in the running for other companies as well.
“LEAP is not in any way or shape designed to compete against what other Indiana cities are doing,” Rosenberg said. “LEAP is designed to compete against international locations that are playing for the same types of companies of the future and other places throughout the United States, like Nashville or Austin, Raleigh, Phoenix.”
Why does the IEDC say Lebanon was chosen for the LEAP District?
Location, location, location. Lebanon is located 45 minutes from Purdue University and Rosenberg said it was relatively easy to piece together enough acreage in the city. Plus, unlike other areas of the state, it’s located within a 30-minute drive to an international airport and can pull from the central Indiana population center for talent.
Why does the LEAP District need outside water?
The IEDC already has a central Indiana source in place to provide 10 million gallons of water a day to the LEAP District. That’s enough to handle the current needs of the district, including those of Eli Lilly.
But, Rosenberg said that won’t be enough water should a high-water user decide to move to the LEAP District, which is the state’s goal. In June, the IEDC announced that Indiana is a finalist for a $50 billion semiconductor plant, the type of industry that depends on large amounts of water.
Rosenberg added that should a high water user not decide to settle in the LEAP District, the IEDC will no longer be involved in water discussions. Regardless, he said water scarcity in central Indiana is an issue that will have to be addressed in the future, even if a major water user doesn’t choose Indiana to expand in.
“Even outside of anything happening at LEAP, this is a problem that is staring the state in the face over the next few decades,” Rosenberg said. “Our premise was can we use economic development to unlock the resources to not only provide additional water for potential companies coming into these areas, but really solve a regional, generational water issue that everyone has identified and known about for decades and decades.”
An Indiana Finance Authority central Indiana water study released in 2021 estimated that the daily water demand in central Indiana would increase by more than 100 million gallons by 2070.
What is Indiana’s water solution?
The IEDC is looking at the Wabash Alluvial Aquifer as a likely solution to its water woes.
IEDC signed a $9 million contract with Black & Veatch Corporation earlier this year to manage water infrastructure. The contract itself outlined a plan to “convey raw water from a series of collector wells and pump stations located adjacent to the Wabash River” for the LEAP district.
But, Rosenberg emphasized the pipeline is not a done deal. At the request of the IEDC, INTERA Inc., has started testing how much water can sustainably be withdrawn from the aquifer adjacent to the Wabash River.
How much extra water does the LEAP District need?
Rosenberg said the IEDC has not placed a number on how much water it would need to pull from the aquifer. That would depend on which companies choose to move to the LEAP District, he said.
Intel in Ohio, for example, is expected to use 5 million gallons of water per day. That’s the kind of water usage Indiana should expect to see if the IEDC lands a chip manufacturer.
Preliminary results from the INTERA study show that two collector wells at the site will sustainably produce more than 30 million gallons of water per day. That’s the equivalent of more than 40 Olympic-sized swimming pools.
The actual amount of water withdrawn could be much larger. Water from the aquifer could be used for other central Indiana uses outside of just the LEAP District, to help address the expected 100 million gallons a day increase in water needs for central Indiana over the next 50 years.
There’s not yet an estimate of the maximum amount of water that could sustainably be moved from the aquifer.
Why are Tippecanoe County residents concerned?
Elected leaders and Tippecanoe County residents are worried that if the IEDC takes water from the aquifer adjacent to the Wabash River, it could negatively impact the county’s water supply and its own ability to expand economically in the future.
“The concern is once you develop that pipeline, Indiana doesn’t have any real rules in place to determine how much can be moved,” Deery said.
Plus, the LEAP District is located well outside of Tippecanoe County, which means the benefits to the community aren’t as obvious as they would have been had the IEDC chosen a location closer to the Wabash River for the development.
Does Tippecanoe have enough water to share?
That’s what the IEDC has been studying.
The preliminary results from the INTERA, Inc. study show that two wells on the site will sustainably produce more than 30 million gallons per day, with “minimal impact on home-owner wells” according to the IEDC.
Those opposed to the project, however, aren’t confident that the IEDC will be able to provide an unbiased look at what the impact on the Wabash River would be.
“Typically, you research before you buy,” Deery said, “and there’s been a sense around here that the decision has been made. And now it’s in search of the evidence to support that.”
What did Holcomb propose to ease concerns?
Last month, Gov. Eric Holcomb directed the Indiana Finance Authority to take over oversight of the INTERA water supply study.
“I am confident that these new efforts led by IFA will provide the necessary data to gain a greater understanding of the amount of excess water that is truly available to support all the surrounding region’s growth prior to any action being taken that could inadvertently jeopardize this needed resource,” Holcomb said in a statement. “ No entity is better suited to lead this overall pursuit than the IFA which will approach this study in the same methodical, collaborative, and transparent manner the organization has conducted in the past.”
Moving oversight of the water study to a different agency was praised by some critics of the project as a step in the right direction.
IFA will also start a comprehensive regional water study for north-central Indiana, expected to be completed in fall 2024.
What is Tippecanoe County doing to try to stop the pipeline?
Last month, Tippecanoe Commissioners unanimously advanced a nine-month moratorium on “high volume water export(s).”
Rosenberg said the commissioners’ moratorium would have no impact on the IEDC’s plans because the agency would not be in a place to pump water from the aquifer in the next nine months.
“I think the action was unnecessary and it was playing to some of the rhetoric and misinformation,” he said.
How will state lawmakers address water during the 2024 legislative session?
Republican legislative leaders say they want to avoid legislating on the water issue until they get the data. That means they have no plans to finance such a pipeline yet.
“We’re not going to take any other steps until we have an opportunity to study to make sure that there’s ample water for the projects that we’re trying to bring into the state of Indiana,” Senate President Pro Tem Rodric Bray said last month, “and we understand just how much is too much to take away from a particular community.”
Those who represent Tippecanoe County, such as Deery, hope to implement some guardrails “that would help protect all communities against any potential harm of large water transfers to another community,” he said in a press release.
What’s next?
The INTERA water supply study is expected to be completed in early 2024. Rosenberg said it’s “too premature” to say whether a water pipeline would move forward without the blessing of Tippecanoe County, should studies show the capacity to move large amounts of water is there.
“We’re not going to in any way inhibit Lafayette from their ability to to grow economically,” Rosenberg said, “because they’ve had so much success already.”
The legislative session convenes on Jan. 8 and must wrap up by mid-March.
Contact Kaitlin Lange on X @kaitlin_lange or email her at [email protected].
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Anne Hathaway, the state’s new Republican party chair, makes history. But who’s surprised?
INDIANAPOLIS — Last August, Anne Hathaway’s phone lit up with a call from Gov. Eric Holcomb. Nearly a quarter-century before, Hathaway had recruited the future governor to run for an Indiana House seat in the only race he lost.
With the resignation of Indiana Republican Chairman Kyle Hupfer in hand, Holcomb asked Hathaway to lead the Indiana Republican Party, and in doing so was tapping the first women to hold the role.
For the past 15 years, Hathaway had led the Richard G. Lugar Excellence in Public Service Series, an organization inspired by U.S. Sen. Richard Lugar and created by Teresa Lubbers and Judy Singleton to develop a gender bench for the GOP.
“I encourage women every day to take a risk, be willing to lose; go out of their comfort zones and run for office or serve on a board or commission,” said Hathaway, who serves as Indiana’s national committeewoman on the Republican National Committee, during a recent, exclusive Howey Politics/State Affairs interview.
“I couldn’t continue to do that unless I was willing to do that myself, willing to take the risk, willing to lead by example,” she said, adding, “When the call came for me, I jumped. Yeah, I’m in. Let’s go.”
Holcomb said in making this historic nomination: “Here are several key reasons I believe Anne is the right person at the right time for this role. Anne’s resume of service to the Republican Party is as extensive as just about anyone’s in the country, having served with distinction at the local, state and national levels throughout her entire career. Furthermore, with experience in running campaigns at every level of government, she has the knowledge and relationships to not only keep our party moving forward, but to continue to take it to the next level.”
Hathaway’s roots are in the tiny Illinois town of Galva just north of Peoria. After graduating from high school with a class of 77, and then from the University of Illinois, she decided to spend a year in Washington, D.C., where she began as a typist at the Department of Treasury.
Hathaway served in the White House as assistant and director of scheduling for former Vice President Dan Quayle, was program director for the 2012 Republican National Convention, and was executive director of the Indiana House Republican Campaign
Committee.
Following Hathaway’s resume is a lesson in stewardship and power.
“Sen. Lugar would be more excited about me being state chair than I am just because, Judy Singleton and Teresa Lubbers were ecstatic,” said Hathaway.
She now helms the party at (or nearing) its historic apex. The Indiana GOP holds all the state constitutional offices, nine of 11 congressional seats, maintains General Assembly super majorities, more than 90% of county offices, and as of the municipal elections earlier this month, 76 mayors. If a Republican is elected governor in 11 months, the party will increase its historic dominance to five consecutive terms.
Hathaway will lead the party through the five-way gubernatorial primary. Following next June’s Indiana Republican Convention, she will head to Milwaukee, where Republican National Chairwoman Ronna McDaniel tabbed her to head the RNC’s Arrangements Committee.
Hathaway has committed to serve only through the May primary. “At that time, she will work together with the gubernatorial nominee and you all to decide who is best to finish out the remainder of the term,” said Holcomb.
Asked if there was a chance to continue as chair beyond the May election, she said, “That’s a conversation to be had.
“I have agreed to stay at least through the state convention. I believe the gubernatorial nominee should have his or her own political partner here. I’m just focused on the time between now and then, she said.
Senior reporter and columnist Brian Howey sat down for a 45-minute, wide-ranging interview with Hathaway where she discussed what it means to make history as the first female state Republican chair, how her work at the Lugar Series prepared her for this new role, the Republican party’s diversity programs and other topics. Read the full conversation on State Affairs Pro here.
Brian Howey is senior writer and columnist for Howey Politics Indiana/State Affairs. Find Howey on Facebook and Twitter @hwypol.
Gov. Holcomb taps Boone County Council president to serve out remainder of Comptroller Tera Klutz’s term
Republican Elise Nieshalla, president of the Boone County Council, will serve out the remaining three years of State Comptroller Tera Klutz’s term.
Gov. Eric Holcomb announced the appointment of Nieshalla, a real estate investor, on Tuesday. As state auditor, Nieshalla will oversee the balancing of Indiana’s checkbooks and payment of all state employees.
“My appreciation runs deep for the strong financial standing of our state and the integrity in which the State Comptroller’s Office is run,” Nieshalla said in a statement. “It is truly my privilege to receive Gov. Holcomb’s appointment to serve our great state and local units of government by upholding the highest standards of fiscal responsibility and offering tremendous Hoosier service.”
Earlier this year Klutz announced she would resign Nov. 30, roughly a year after she was reelected. Klutz, who was first appointed by Holcomb in 2017, is the fourth state auditor in a row to not finish their term, enabling the sitting governor to choose a replacement.
Nieshalla was already well-known within Republican circles. She previously ran for treasurer in 2022 against three other Republicans, losing to current Treasurer Daniel Elliott at the state Republican convention. At the time, the convention loss of Nieshalla and other Republicans more closely aligned with the party establishment was seen as a rebuke of the Holcomb wing of the party.
Nieshalla, who lives in Zionsville, is also president of the Indiana County Councils Association and the chairwoman of the Association of Indiana Counties’ 2023 Legislative Committee. She has a bachelor’s degree from Oral Roberts University and a master’s degree from Indiana University.
She’ll be sworn in on Dec. 1 and will serve until at least the 2026 election when voters will have the option to choose the next state comptroller.
Holcomb praised Nieshalla in an emailed statement.
“Elise is a dedicated and proven public servant who has committed much of her professional life to bettering her community through service,” Holcomb said. “She has shared her financial expertise to help steer and shape the bright future of Boone County which gives me great confidence she’ll do the same serving Hoosiers as our next State Comptroller.”
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Five issues likely to come up next legislative session, and two that won’t move
The gist
On Tuesday, Indiana lawmakers returned to the Statehouse for Organization Day, the ceremonial start to the legislative session, ahead of what legislative leaders are saying should be a low-key, short session.
“We’ll probably take a pretty measured approach on what we address … , maybe fine tune some things,” House Speaker Todd Huston, R-Fishers, said during an Indiana Chamber of Commerce legislative panel on Monday. “Short sessions are supposed to be for emergency items only.”
Not only will 2024 be a non-budget-writing legislative session mandated to end by mid-March, but this session also falls in the midst of a heated Republican gubernatorial primary. There’s no obvious assumed winner who can lead policy discussions ahead of the election, nor has Gov. Eric Holcomb laid the groundwork for any major policy changes in his last legislative session.
Plus, recent criminal corruption charges against a former lawmaker — and the potential for other lawmakers to be charged in connection with the case — has put a cloud over the Indiana General Assembly.
Still, some minor bills are expected to move, and something can always pop up. Here’s a breakdown of some of the issues State Affairs expects to be debated, and three that probably won’t move.
Reading proficiency
Both Huston and Senate President Pro Tem Rodric Bray, R-Martinsville, said they want to limit the situations in which schools allow third graders to advance to fourth grade when they fail the IREAD-3, the state’s reading comprehension test.
During the 2021-2022 school year, more than 18% of students failed the test because they were not reading at a third grade level.
“When you pass that kid on, and they aren’t prepared to succeed, you’re not doing that kid a favor,” Huston said, following his Organization Day speech in which he laid out his caucus’ priorities.
Huston’s goal is to make Indiana the No. 1 state in the nation for third grade reading proficiency by 2027.
Democrats cautioned that it may be too soon to make major changes to how IREAD scores are handled in Indiana. During the 2023 legislative session, lawmakers passed a science of reading bill.
“We need to make sure that schools have the opportunity to train their teachers, to implement these strategies across the board before we start throwing new legislative hurdles in the way,” said Sen. Andrea Hunley, D-Indianapolis. “We have to give [new recommendations] time to work before we start, say, failing all children or retaining a whole class of children.”
Continuing to re-think K-12 education
Last legislative session, lawmakers passed a bill seeking to expand work-based learning in high school, but Huston emphasized during his Organization Day speech that legislators can still do more to transform the K-12 school system.
Huston said House Republicans will push to allow state money typically set aside for students pursuing a college education to be used to obtain certificates and certifications for “high demand, high wage jobs.”
“We must continue to adjust the way we think about K-12 education in order to meet the needs of all students, including those who aren’t interested in pursuing a two-or four-year degree,” Huston said. “Let’s use this session to build on skill and work-based learning, and let’s align our funding to this goal.”
This fall the Indianapolis Chamber of Commerce took a delegation of Indiana lawmakers and others to Switzerland to see how the country’s apprenticeship program operates. Expect more changes in the coming years that would enable Indiana’s K-12 system to more closely mirror that of Switzerland’s.
Child care access
During his own Organization Day speech, Bray emphasized a need to expand affordable child care options for young children.
“Day care is a constant challenge from the Ohio River to the Michigan line, trying to find day care at all if you can find it and whether it’s affordable,” Bray said.
He pointed to a legislative study committee on the topic which recommended some minor reforms to the system, such as lowering the age requirement for working unassisted in an infant or toddler classroom to age 18 from 21 and requiring the state to review how it can streamline child care regulations to increase availability.
Don’t expect lawmakers to throw more money at the child care system since 2024 isn’t a budget-writing year.
Health care costs
Lawmakers passed multiple bills during the 2023 legislative session aimed at cutting health care costs, ranging from limiting physician noncompete agreements to creating benchmarks for how high hospital prices in the largest hospital systems should be.
But Bray said he expects lawmakers to offer more legislation on the topic this year in order to help drive down costs long term.
A legislative study committee on the topic backed recommendations to require more disclosures by insurance companies on their “prior authorization” process for medical care, as well as require medical providers to give lawmakers a six-month notice for mergers or acquisitions.
Water access
It’s unclear whether legislation on water access will actually pass either chamber, but the topic is almost certain to come up in discussions.
Earlier this year, the Indiana Economic Development Corp. announced plans to pump water from the Wabash River aquifer to the LEAP district in Lebanon. Tippecanoes citizens have been vocal in their opposition to the plan, and just this week the Tippecanoe County Commissioners voted to put a moratorium on high volume water exports.
Legislative leaders say they want to avoid legislating on the issue until they get more data. The Indiana Finance Authority and the Indiana Chamber of Commerce are studying the issue.
“We’re not going to take any other steps until we have an opportunity to study to make sure that there’s ample water for the projects that we’re trying to bring into the state of Indiana,” Bray said, “and we understand just how much is too much to take away from a particular community.”
But, even if leadership would rather wait to address the elephant in the room, lawmakers are almost certain to file legislation.
Issues that won’t move: Gaming
For at least the past two legislative sessions, lawmakers have filed bills to legalize internet casino gaming, or iGaming. It appeared momentum was on proponents’ sides. Until this month.
Earlier this month former state Rep. Sean Eberhart agreed to plead guilty to criminal fraud charges that federal prosecutors say stem from influencing casino legislation in return for the promise of a $350,000-a-year job.
Both Bray and Huston said Monday they don’t expect any gaming legislation to move in 2024.
During Monday’s Chamber panel, Bray said the federal investigation “makes gaming extremely hard to engage in.”
“It taints the Statehouse, it diminishes the confidence that people have in the integrity of the Statehouse, it causes an awful lot of problems and it makes it particularly difficult to engage in that kind of policy,” Bray said.
Issues that won’t move: Marijuana
Lawmakers studied the impact legalizing marijuana would have on the workforce and youth in an interim committee this fall, but the committee never issued any recommendations for legislation.
Both legislative leaders and Holcomb have emphasized their reluctance to legalize marijuana until at least after the federal government reschedules it. Huston reiterated his hesitation on Monday.
“No one has made a compelling case to me yet on why legalizing marijuana or having more people use cannabis in the state of Indiana is a positive thing,” Huston said. “So until I hear that answer, I wouldn’t expect a whole lot of change.”
Likewise, Bray said its passage “seemed unlikely.”
What’s next?
The ceremonial start of the legislative session is just that. Lawmakers won’t start moving bills until they return to the Statehouse in January.
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