Braun health care plan builds on legislative action that previously failed

Republican candidate for governor U.S. Sen. Mike Braun released a six-prong health care plan on Thursday, providing an advance copy to the Indiana Capital Chronicle that outlined the sitting U.S. senator’s priorities for the Hoosier State—many of which expand upon previous General Assembly proposals.

In contrast to Gov. Eric Holcomb, who largely stayed out of ongoing legislative negotiations, Braun firmly put his thumb on the scale in favor of one perspective over another across several contentious, ongoing discussions—from the regulation of pharmacy benefit managers to prohibiting noncompete clauses for health care workers.

The politician has relied heavily on his health care expertise throughout the race to succeed the term-limited Holcomb, repeatedly highlighting his own experience as the owner of southern Indiana’s Meyer Distributing and his work on the federal level.

“As a Main Street Entrepreneur who took on rising health care costs in my own business, I know firsthand that the high cost of health care is a glaring weakness when it comes to attracting new companies and new residents, along with the burden on hardworking Hoosiers and business owners,” Braun said in the release. “Solutions such as transparency, innovation, competition, and empowering consumers are not hard to figure out, and I will provide the leadership required to deliver solutions to lower the cost of health care for Hoosiers.”

The six pillars of the plan—quality, cost, transparency, access, wellness and competition—explicitly build upon the work of the General Assembly, which “has set a firm foundation for more ambitious work,” according to an accompanying white paper.

As with prior proposals, Braun’s plan is supported by research from the conservative Hoosiers for Opportunity, Prosperity & Enterprise, or HOPE, Inc., a not-for-profit arm of the campaign based in Terre Haute.

The plan didn’t include any fiscal analysis and will need to get buy-in from the same lawmakers who failed to pass similar proposals. Braun will face Democrat Jennifer McCormick and Libertarian Donald Rainwater in the general election and the deadline to register to vote is Oct. 7.

Wading into ongoing Statehouse discussions

The HOPE document starts by characterizing the state’s health care prices as “robbing Hoosiers’ paychecks” through “rising insurance premiums, lofty prescription drug costs (and) staggering hospital bills.”

Earlier this year, the National Healthcare Price Transparency Conference unveiled a study that ranked Indiana’s hospital prices eighth-highest in the nation—just before honoring Braun for his health care legislation at the federal level. One of the groups behind the conference, the Employers’ Forum of Indiana, has been a vocal critic of hospitals at the state level and pushed for several pieces of legislation to curb high prices by adding hospital regulations.

Notably, at least one major hospital CEO supported Braun’s opponent in the Republican primary and encouraged his peers to do the same.

The HOPE white paper takes this employer perspective further, adding that “the high cost of health care not only puts a strain on families, but also on employers who are looking to relocate to the state or expand their footprint.

“For every advantage Indiana’s business-friendly tax environment gives it over its peers, the state suffers an equal or greater disadvantage from high health care costs,” the paper said.

Braun would push for more data sharing during insurance negotiations as well as allowing “employers and other group health plan sponsors to access, audit and review their claims encounter data.”

Insurers have resisted sharing this information, saying it’s a “trade secret.”

The plan goes into heated debates from previous legislative sessions, including the prohibition of noncompete clauses at non-profit hospitals—though the Federal Trade Commission already attempted to ban such agreements at the for-profit level and now faces a legal challenge. A previous proposal that would have banned noncompete agreements in the health care sector was ultimately limited to just primary care doctors following pushback.

The document suggested increasing regulations for pharmacy benefit managers, who negotiate drug prices between manufacturers, insurers and distributors like pharmacies.

“In practice, these middlemen between pharmacies and drug manufacturers have only driven up the cost of prescription drugs,” the paper said—a position similar to one struck by the Federal Trade Commission, which recently announced it would be pursuing legal action against the nation’s three biggest PBMs.

But lawmakers have struggled to take action on PBMs and restrict rebate spending, instead requiring the entities to register with the state and instructing the Department of Insurance to collect claims data.

Additionally, efforts to reform prior authorization at the state level have hit repeated roadblocks, but Braun advocated for prohibiting insurers from rescinding prior authorization and would require denials be made by medical professionals with “similar credentialing as the requesting physician.”

Other long-standing issues—such as expedited credentialing for doctors, medical licensing reciprocity, site neutral pricing and credits for health reimbursement arrangements—are also frequent priorities for lawmakers that have encountered lobbying opposition at the statehouse.

Under the plan, the Indiana Graduate Medical Education fund would be required to prioritize rural training placements for obstetricians to address coverage gaps, among other provisions to reduce ongoing physician shortages. Repeated public testimony has concluded that monopolization and consolidation have driven up Indiana’s health care prices, which Braun proposes combatting by incentivizing new primary care facilities through a revolving fund under the Indiana Finance Authority. The fund would be established “by leveraging Indiana Economic Development Corporation dollars,” though that process wasn’t immediately clear.

Other pro-competition tenets include strengthening the state’s anti-trust laws “by requiring all private equity mergers and acquisitions in the health care industry” to have the Attorney General’s seal of approval. The office would also be able to block certain merger actions. Currently, the office can only review and request information about such consolidation in deals valued at $10 million or more.

Medicaid provisions

Part of Braun’s plan would require Medicaid enrollees consult with a primary care physician before accessing an emergency room in non-emergency cases while incentivizing commercial health plans to do the same. Emergency rooms are one of the most expensive forms of health care.

This would also require Medicaid enrollees to have better access to primary care doctors. Fewer doctors participate in Medicaid because of low reimbursement rates. To reverse this, “the State should allow Medicaid patients to access program dollars to support a direct primary care practice relationship,” the paper concluded.

Such work would be accompanied by health literacy materials emphasizing the importance of primary care for Medicaid beneficiaries as well as the general public.

Reducing Medicaid costs—which are paid for by the state and federal government—will be a key discussion in the 2025 budget-writing session in which lawmakers will have to draft a long-term funding plan for the entitlement program, which is the fastest-growing portion of the state’s budget.

Other Medicaid provisions, scattered across several of the plan’s pillars, include:

• Allowing Medicaid to reimburse providers for continuum of care services across separate facilities
• Setting “clear metrics to assess quality of care and patient outcomes” under PathWays for Aging, a managed care program that launched in July, alongside better transparency and accountability safeguards
• Independent audits for Medicaid claims (as well as audits for claims under the State Employee Health Plan)
• Expanding telehealth for Medicaid enrollees

Lastly, Braun aims to empower the Attorney General’s Medicaid Fraud Control Unit to partner with the Family and Social Services Administration to investigate alleged overpayments, duplicative claims or other suspicious billing under Medicaid. This comes on the heels of a whistleblower suit alleging that the agency overlooked $700 million in misspent funds.