USA TODAY International Edition
Hoosiers have key positions on Trump’s health care team
Led by Pence, they come from one of the unhealthiest states
Several Hoosiers in key positions in the Trump administration, led by Vice President Mike Pence, are negotiating the future of federal health policy despite the state’s mixed reputation on health care.
Indiana spends less on public health funding than any other except Nevada, a handicap when Indiana was home to the nation’s first HIV outbreak linked to the injection of oral painkillers in 2015.
In addition, the state for years has ranked among the least healthy. Hoosiers smoke more, are less active and die sooner than most Americans.
Before Pence became vice president, however, he was among the minority of Republican governors who expanded their state’s Medicaid program — a move which gave hundreds of thousands of Hoosiers access to health care and helped the state respond to the HIV outbreak.
Pence has been a leader of the Trump administration’s so- farunsuccessful efforts to repeal the Affordable Care Act, including phasing out its Medicaid expansion — a program Pence’s successor is using to fight the opioid addiction epidemic. Another former Pence health policy aide now helps Health and Human Services Secretary Tom Price — a good friend of Pence’s — work with Congress on the agency’s legislative agenda.
Long- time Pence aide Matt Lloyd, the top HHS spokesman, is the “sherpa” to help guide the Trump administration’s surgeon general nominee through Congress.
President Donald Trump’s pick? Indiana’s state health commissioner, Dr. Jerome Adams, who was appointed to his position by Pence.
“It’s certainly significant,” Eliot Fishman, the CMS official during the Obama administration who worked with Indiana on granting approval for its alternative Medicaid program, said of the concentration of Hoosiers in health policy positions. “But, for myself, I was hopeful that having people who had successfully negotiated, and then implemented, an innovative Medicaid expansion in Indiana would have led to more support for Medicaid expansion nationally. I have not seen evidence of that yet.”
Tom Miller, a health policy expert at the right- leaning American Enterprise Institute, said it’s understandable that so many Pence people ended up in key health care positions.
“It didn’t light up President Trump as the thing he was most deeply invested in, and had a range of experience in,” Miller said. “Mike has some experience, knowledge and engagement in this area of policy — more so than most other folks close to the issue in the White House. So it’s not surprising that he is taking the lead on this.”
Indiana is home to some significant players in the health care industry. Anthem, one of the largest insurance companies, is headquartered in Indianapolis, as is drug maker Eli Lilly and Co.
Warsaw, Ind., is known as the “Orthopedic Capital of the World” because of the concentration of medical device makers.
And health savings accounts, the tool Republicans have championed as a way to make consumers more invested in their health care decisions, were pioneered by an Indiana insurance entrepreneur as an alternative to traditional health insurance. ( The alternative Medicaid program Verma helped Pence create for Indiana’s Medicaid expansion mimics aspects of health savings accounts.)
Yet, despite Indiana’s leader- ship in sectors of the health care industry, the state ranks near the bottom on many health measures.
On the most recent overall ranking by the United Health Foundation, Indiana comes in at 39th healthiest.
That scale takes into account behaviors, environmental health, policies, clinical care and outcomes.
Not surprisingly, the category that stands out the most to Paul Halverson, dean of Indiana University’s Richard M. Fairbanks School of Public Health, is public health funding. Indiana’ ranks 49th on spending per capita on preventive and education programs that improve health.
“We just have not prioritized public health funding in Indiana in a number of years,” Halverson said. That’s despite the fact, he said, that studies show properly funded public health systems can reduce medical care expenditures and increase life expectancy.
The HIV outbreak in Southern Indiana put a spotlight on the weaknesses in the state’s health infrastructure.
Still, Halverson gives a lot of credit to Adams — the state health commissioner poised to become the nation’s top doctor — for how he worked with Pence to respond to the outbreak. The response included allowing needle exchanges despite Pence’s initial reservations.
Pence’s successor, Indiana Gov. Eric Holcomb, has made reducing the number of opioid deaths one of his top goals as governor.
But Holcomb’s strategy to fight the opioid epidemic relies heavily on Medicaid, the jointly funded state and federal program which Pence is pushing hard to curtail.
“Mike has some experience, knowledge and engagement in this area of policy.” Tom Miller, American Enterprise Institute