Indiana public health expansion clears key legislative vote

Indiana lawmakers gave a key sign of support Monday for the governor’s proposal that would broadly expand the state’s support for county-level public health programs toward improving the state’s poor national rankings in areas such as smoking, obesity and life expectancy.

Indiana House members voted 78-21 in favor of the bill, with opposition coming from among the most conservative Republican members. Those votes against the proposal came despite changes to specify that elected county officials can opt out of the state program at any time since the Republican-dominated Senate endorsed the bill in February.

House Public Health Committee Chairman Brad Barrett urged support for the proposal, saying that county health programs are “strapped” for resources and those troubles were magnified by the COVID-19 pandemic.

“It only brought to light the fact that this was uncoordinated and poorly funded,” said Barrett, a Republican from Richmond.

The bill lays out “core public health services” for which county health departments would be directed to provide with acceptance of more state funding. Those would include access to required childhood vaccinations, emergency preparedness, restaurant and sewage system inspections, communicable disease prevention and smoking cessation programs.

House and Senate negotiators face a deadline by the end of next week to reach agreement on a final version of the plan. They also face determining how much state money to direct toward the funding boost from the current $7 million a year that goes toward county health departments, which are primarily funded by local taxes.

Lawmakers have whittled down Republican Gov. Eric Holcomb’s request for nearly $350 million over the next two years for county health funding and other initiatives such as improving the state’s trauma care network. House and Senate budget proposals have reduced the state funding to at most $225 million.

Senate Appropriations Committee Chairman Ryan Mishler said last week that several Republican senators have had concerns about state officials possibly taking more control over local health departments.

While county officials would have the option of accepting the money and expanding services, some opponents with complaints over government-ordered COVID-19 precautions said during legislative committee hearings that they feared creeping state authority over local health agencies. Plan opponents focused on issues such as complaints over federal approval of COVID-19 vaccines and Holcomb’s executive orders early in the pandemic for business closures and a face mask mandate.

Republican former state Sen. Luke Kenley, who was co-chairman of a Holcomb-appointed commission on public health, said Indiana needed to improve county public health department funding from its 45th-place national ranking even in the face of “vociferous” opponents.

“They’re still fighting the wars of the pandemic about vaccinations and mask and mandates and somebody’s telling us what to do,” Kenley said.

Similar grievances were aired to Indiana lawmakers as they debated a proposal last year that failed to win passage aiming to severely limit the COVID-19 vaccine requirements that businesses could impose on employees.

Holcomb has made the public health proposal one of his top priorities for the new two-year state budget. Pointing to Indiana’s rankings near the bottom nationally in areas including obesity, smoking and life expectancy as “a pattern we need to reverse,” Holcomb has said “We need to get healthier as a state, there’s just no two ways about it.”