Public Health Infrastructure Bill Moves Forward

By Whitney Downard

A bill earmarking funding for local public health departments advanced through a Senate committee Wednesday, despite the outcry of COVID-19 misinformation and state dictatorship.

The bill, which has no price tag yet, moves to Senate Appropriations for further funding discussion.

“In one sense, Senate Bill 4 is actually an infrastructure bill regarding public health and preventative health services designed to ensure that every county in the state provides coordinate services,” former Sen. Luke Kenley told lawmakers. “We don’t build a road system and then neglect; we don’t build local schools and then not staff them. The same is true for public health.”

Kenley, along with former State Health Commissioner Judy Monroe and current commissioner Kris Box, led the Governor’s Public Health Commission, crafting a series of recommendations to boost Indiana’s dismal public health outcomes.

Asking for less than the Governor’s Public Health Commission originally suggested, Gov. Eric Holcomb is pursuing $120 million in fiscal year 2024 and another $227 million in fiscal year 2025 to increase public health services across the state.

When compared to the national average, Indiana has higher rates of tobacco use, more diabetes diagnoses, and higher maternal and infant mortality rates – all areas public health is designed to combat. As a whole, Indiana underfunds public health, with 88 counties spending less than a quarter of the national average on their residents.

Under the legislation, counties who accept enhanced funding for their health departments from the state government must meet higher quality standards designed to better address Indiana’s public health shortcomings. Additionally, it creates a commission dedicated to studying the state’s trauma care, which many rural Hoosiers can’t access.

In order to become nationally accredited, entities must provide the ten essential public health services, as outlined by the Centers for Disease Control and Prevention. Examples include monitoring population health needs, educating the community, enabling equitable access and more.

In this bill, local health departments must provide maternal and child health services as part of their core offerings. Counties who opt into the funding will report their health metrics, which will be published by the Department of Health.

Issues with bill language

But while business leaders, local elected officials and health care providers broadly supported the bill, some worried about the details.

In particular, testimony highlighted problems surrounding vision screenings in school. Currently, children can be screened in either kindergarten or first grade while this bill requires screenings both years – which adds an expense for local schools.

But many schools – nearly one in four – request a waiver from screening requirements from the Department of Education, meaning that many students may go without the vision test. However, it isn’t clear if those schools chose to conduct screenings in another method.

“It is important, after children undergo a vision screening and fail, that the public health apparatus kicks into place to ensure that those children are then followed up (with) appropriately and are given the opportunity for further testing,” ophthalmologist Louis Cantor, an Indiana University professor, said. “The goal is to screen all Indiana school children.”

However, in order to increase the number of students getting tested, the bill lowers the bar for screenings – though Cantor said the lesser standard would still be effective.

Bradley Rogers, the president of the Elkhart County Commissioners, said there would be a lot of pressure on local health departments to accept the money, even if they didn’t agree with the attached strings. In particular, he worried that his local health department would be held to a new standard of care.

“This bill means nothing to your county if you just say no,” bill author and committee chair Sen. Ed Charbonneau, R-Valparaiso, said.

Earlier testimony from the Indiana Association of County Commissioners indicated that 85% of their members approved the bill as written.

Kellie Streeter, president of the association and Knox County Commissioner, said that current grants didn’t go far enough when it came to covering costs.

“We do feel that this provides local health departments and counties (the chance) to provide a service that is woefully needed,” Streeter said. “There was some trepidation but our concerns with local control have been addressed.”

COVID, vaccine misinformation swarms legislators

A flurry of testimony against the bill mostly consisted of vaccine misinformation and denigrating the senators for introducing the “tyrannical” bill that enabled “child abuse” and a “state takeover” of local health departments.

The hour-plus of negative testimony didn’t appear to sway senators, who unanimously approved the bill, though with reservations.

“We need to do something but I don’t know if this is the right something,” said Sen. Mike Bohacek, R-Michiana Shores. He noted that some of the negative testimony came from his constituents.

But other senators hadn’t heard any local opposition, including Sen. Vaneta Becker, R-Evansville.

“We have a high infant mortality rate, high maternal mortality rate… lots of health issues in this state,” Becker said. “I think this bill will help.”

Other senators said the bill needed work on its vision screening language as well as the relaxing of requirements for county health officers. Under the bill, those officers no longer need to be doctors and can be advanced practice nurses, which some people didn’t like.

Other bills in the Health Committee

Senators also unanimously approved a statute change to allow health providers to use abandoned long-acting reversible contraceptive devices. Under previous language, only the assigned Medicaid recipient could use the device – even if that recipient later changed their mind about the procedure and didn’t complete the process.

Additional legislation simplifying regulations for home health agencies received zero ‘no’ votes. The bill allows for remote supervision of employees and doesn’t require a physical presence in a county to provide services.

Home health agencies would no longer be required to drug test their employees – something that staffers at nursing homes aren’t required to do. However, companies can still test at their own discretion.

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