Q&A

Q&A: Health committee chair Sen. Charbonneau talks health care costs, child care and upcoming session

Sen. Ed Charbonneau, R-Valparaiso, speaks with Sen. Justin Busch, R-Fort Wayne, on the Senate floor on April 25, 2023. (Credit: Mark Curry)

This interview is part of a series of Q&As  with committee chairs ahead of the 2024 legislative session to discuss the legislation that could move through their committees. 

Health care dominated the 2023 legislative session, from a massive increase in both mental and public health spending, to multiple bills aimed at lowering health care costs for consumers. 

The upcoming 2024 legislative session certainly won’t be that. 

State Affairs spoke with Sen. Ed Charbonneau, chair of the Senate Committee on Health and Provider Services, about what issues he expects to see in his committee during the short legislative session, including more legislation targeting health care pricing. He also talked about a bill he plans to file that aims to increase child care access. 

This conversation has been edited for clarity, brevity and length.

Q. What issues do you expect to focus on in your committee this upcoming legislative session?

A. We’re in a short session. Leadership is saying this is going to be fast — in and out, no big controversial issues. 

We can look to summer study committees to get an idea of what may be coming down the road with certainly the [Interim Study Committee on Public Health, Behavioral Health, and Human Services] where we made recommendations on child care and psilocybin. [Some states have decriminalized psilocybin , a substance found in psychedelic mushrooms.]

The child care issue is much bigger than I realized it was before we discussed it in the summer study committee. I describe child care now as another infrastructure issue for the state of Indiana. It affects every aspect of our economy. When everybody's struggling to find people to work, this is an issue that can help allow people to go to work who might not otherwise.

The psilocybin issue, I would like to get more information on that. It certainly seems to be a promising treatment for PTSD and various other mental health issues. It's only been studied. John Hopkins University has done studies, but I would like to encourage, whether it’s Purdue or IU, to maybe do some studies.

This is a non-budget year and I am planning at this point on not having bills that have a fiscal impact. I don't know what the cut off will be, because we generally have a cut off of, whether it's $100,000 or whatever fiscal impact, that it would have to go over to [the Senate] Appropriations Committee. I just don't see in light of everything going on that they'll be welcoming many issues with a fiscal impact.
The Health Care Cost Oversight Task Force had a summer study committee report with some recommendations there, too. 

I recently polled the members of the health committee to see what they had on their plate and there isn't a whole lot. So I think it could be a relatively calm session there. 

One more that I'm toying around with is the 340B [drug pricing] program. It's a federal program that deals with the drug manufacturers getting their pills down to the hospitals that treat a lot of Medicaid patients, uninsured patients, such as Methodist Hospital up in Gary. That was the original intent, but I would like to get some more information on that.

Q. Can you explain what the 340B program is?

A.340B is the federal law that provides for drug manufacturers to sell mainly in underserved areas [at a] dramatically reduced price. The intent is that [hospitals] would be able to then prescribe much cheaper than they would be able to without the program. It just seems like the original legislation was horribly drafted at the federal level. 

The intent was to provide drugs to those that can't afford them, and if that's the case, you wonder why we're getting so many folks that are turned over to collection agencies. The hospitals are also supposed to use that money that they're saving to do the kinds of things not for-profits should do, and it’s just not being done. 

I'm sure the hospitals, maybe the [Eli] Lily’s of the world, are going to say, ‘Stay out of it. Don't make changes. This is a federal program. We don't want a mishmash of 50 different bills or requirements from 50 different states.’ I'm not doing that; I just want information. 

Q. Is the concern that the hospitals are pocketing the savings associated with this program, instead of passing on the benefits?

A. Yea, and not using that money for care. The intent is they use those savings for the good of the people that need the help. I don’t think it’s being done. 

Q. What are some of the other bills we might see your committee talk about this year to further reduce health care costs?

A. We're still relatively early in the bill filing process, so I don't have a good feel for what all is out there. With the short session, it will be difficult to take on big things. I think two issues to watch what happens in the future is with prior authorization and the 340B program.

Q. You mentioned the Health Care Cost Oversight Task Force issued a number of recommendations to address health care costs. Could you walk me through the recommendations?

A. A lot of these [recommendations] are just getting information. One of the things was just making it clear that the employers possess ownership and control of all the health care data relating to their covered lives, allowing an employer to conduct a third party audit of their health care claims and payment data [and] prohibiting spread pricing. 

[Another recommendation] requires hospitals to give notice six months prior to the date of a merger. We're pretty much a state that has an oligopoly of some five large hospital systems.

I've said time and time again that we have not-for-profit hospitals that are operating as for-profit, when you look at, for example, up in Northwest Indiana, where there's a hospital in Hammond that closed. This is an area [with a large population of] Medicaid and uninsured folks. 

Another probably significant recommendation is requiring the [pharmacy benefit managers], third party administrators, employee benefit consultants and insurance brokers to act as fiduciaries for the group plan that’s being represented.

And then [there was a recommendation to look] at Indiana physician reimbursement rates. 

Q. Do you expect movement this year on Indiana physician reimbursement rates?

A. In this session, no, because we don't have the data. This is requiring that the data be reported. I would anticipate that there would probably be something during the 2025 session

Q. Last legislative session was a big health care costs session. Do you think those bills did enough, or do you think there's still more to do to reduce health care costs for Hoosiers?

A. I'll start with Senate Bill 4. That's the $225 million that we are going to be distributing to 86 of the 92 county [health departments] that signed up to be a part of this. We need to watch this; we need to watch how the money is being spent.

Bigger picture wise, this is a paradigm shift as I see it for the state of Indiana. We're actually going to focus on preventing people from getting sick as opposed to treating sick people. That's not going to happen overnight, and we have the funding for two years. So we're going to have to go back in two years and request more funding. Hopefully people feel that it's making a difference in our counties. There aren't going to be any dramatic increases in just two years, but we're going to have to show progress of some kind. That’s troubling to me.

Q. How will that law impact health care costs?

A. This ultimately should have a huge impact on costs, because we as a state [have] really good hospitals that give good service, good treatment, very expensively. 

This is going to keep people out of the hospital, and it drives costs down. If you look at this long term, which we have a problem doing at times, there's no question in my mind it's going to reduce the cost of health care. 

Q. What will be in the child care bill you plan to file?

A. Most of it is going to be administrative type changes — lowering the age, letting maybe high school students work in the child care area if they have supervision all the time. [We want to allow] two or three companies to come together and form a child care facility. 

It is tricky because I didn't want to have anything that was going to have a fiscal impact. So we've threaded the needle, I do believe, and these will make a difference.

Q. What problem will those administrative changes solve in Indiana right now?

A. It will allow more spaces to be opened up. It will create the possibility of one authorization for a child care center to cover maybe three places. If they have two different Boys and Girls Clubs in two different areas up in Northwest Indiana here, they each have to go through their own process and pay for everything. This allows them to do just one to cover several different entities.

Q. Do you think that there can be a huge difference in child care access without more money?

A. I don't want to answer that one, because it’s going to take more money. Like with every other business in every other sector, the number one issue is people, employees. [We] need to pay who we have more and need to get more people to be able to work in, and be willing to work in, these child care settings.

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