Senator Mike Bohacek discusses Senate Bill 4
MARSHALL COUNTY — Indiana Senator Mike Bohacek met with the Marshall County Council and Commissioners in a Joint Work Session to discuss legislative items Friday morning; the discussion focused on Senate Bill 4 also dubbed “The Health Care Bill”. Representatives from the Marshall County Health Department (MCHD) were also present. If the bill clears appropriations it will come back before the Senate for Second Read amendments before the final vote before going to the House of Representatives. There is still time to weigh in on the issues and make changes.
Health Outcomes
Senator Bohacek explained that health outcomes in the State of Indiana are below average as compared to other states and the goal is to direct spending to local health departments to help communities move the needle in the right direction to at least average with the rest of the country. The ultimate goal was to ensure that the same amount of funding is available per person in the State of Indiana; but not micromanage how that funding should be used as every community has unique needs.
Summary of Bill
Items on the expanded list of services addressed in the Bill include but are not limited to Food Protection, Communicable Disease Prevention and Control, Screening and Case Management for Childhood Lead, Pest and Vector Control, Inspection and Testing of Public Pools, Residential Onsite Sewage Systems, Orders for the Decontamination of Properties used to make Meth, Sanitary Inspections of Buildings, Sanitary Operations of Tattoo Parlors, Body Piercings and Eyelash Extensions, access to Immunizations and Tobacco Cessation, Child Fatality Review, Suicide, and Overdose Fatality Review, testing and counseling for Human Immunodeficiency Virus (HIV) and Hepatitis C, Health Promotion Education, Emergency Preparedness, referrals to Critical Care for Health Screenings, Prenatal Care and Substance abuse Disorder. “That’s what this does and the price tag is about $300 million.” He asked the Council, Commissioners and the public present on direction on how best to utilize the funding to create greater positive health outcomes.
Trauma Centers Bohacek
noted that the most impactful item in Senate Bill 4 to him was the study on Trauma Center Availability. Indiana has approximately 11 or 12 Level One / Level Twotrauma Centers in the State. A hospital might be able to stabilize a high level trauma patient; but they won’t be able to treat them which will result in the need to be transported somewhere else. “There is direct correlation in survivability of an accident in a trauma event and your location to a trauma center.” Senator Bohacek said that number is 20 to 30 minutes to have the best results.
Local Control
Senator Bohacek addressed the concern by some communities as to whether the Bill is a relinquishment of control. Councilman Jesse Bohannon validated that concern. He noted conflicting information in content and tone during multiple presentations that he has been audience to and asked for clarification on several items emphasizing the concern on the breadth of the scope of power being given to the State Department of Health. Bohannon noted that at this time the “truth is in the language of the Bill” being presented and quoted a section of the Bill that stated, “allows the State Department to issue guidance to local health departments.” He added, “My guess is that it probably wouldn’t be included in the Bill if it already existed. So I’m guessing that’s an increase in power for the State Department.” He stated confidence in the local health department and emphasized a desire to maintain local control. Senator Bohacek validated some confusing language in some of those presentations and validated that with any funding comes “strings attached” though did not anticipate government overreach. He agreed that those parameters and expectations need defined.
Opt-in / Opt-out
Councilman Tim Harman expressed concern that if a county opts out of the program, will they be denied certain essential services and the ability to apply for funding. Harman argued that if it is truly an option for counties to participate then they should not be penalized with denial of essential services or funding. Senator Bohacek could not confirm exactly how the opt-in / opt-out option is defined and offered to seek further clarification and update government leadership with his findings.
Mental Health
Bohannon said that it would be most effective to look at the “Cause of Causes” and emphasized a need to explore mental health which impacts Criminal Justice, Physical Health, and Substance Abuse issues. He said he hopes there will be a big push to increase the number of qualified Mental Health Professionals in to the field.
Senator Bohacek responded that Senate Bill 1 tackles mental health more validating that mental health is not only a big issue in the state but the entire nation. He illustrated that eliminating in-patient mental health facilities placed a great burden on prisons, county jails, and hospitals because out-patient treatment works for some people but not for others. He said there was nothing in that bill he opposed and it provided more resources locally without infringing on local control.
Impact to Marshall County
Councilman Will Patterson asked if the Bill is passed as-is; how will Marshall County be impacted. Senator Bohacek said that it changes the funding source - more funding will come from the State of Indiana and less locally. He could not see much impact structurally in terms of how the MCHD runs apart from some additional reporting requirements.
Testimonials
Harman asked which organizations are for / against the Bill. Senator Bohacek was unable to provide a complete list of testimonials but said the Bill has wide range support. Those opposed are concerned about control issues and include private citizens and church groups. “The Bill does some good things. If it can increase and improve overall health in Indiana - it’s great. It saves the State money, it saves employers money, it saves me money on my health insurance and everybody else. It’s all good if it works.”
Marshall County Health Officer Dr. Holm
Commissioner Kevin Overmyer asked Marshall County Health Officer Dr. Byron Holm weigh in. Dr. Holm said he believed that the intentions and initiatives of the Bill are good. “Our main job is to increase the health and wellness of our community and that is done mainly by prevention. We are not the acute treaters of that, we are the prevention of those things. So any dollars and cents that we could get that would help develop all of these areas within our county will improve the health and wellness of our county.” He also emphasized a need for more mental health support; including suicide prevention. While MCHD does promote health and wellness education; Dr. Holm said there is a population who prefers the ease of a pill as opposed to life change which can be a challenge to inspire. Education is the key; though it can be a slow process.
Freedom / Flexibility
Senator Bohacek wants for communities to have the freedom and flexibility to use the resources in a way that benefits each community the most. MCHD can use the funding from the State of Indiana for their 20% for the program. There will be no excess money coming out of County coffers. Senator Bohacek said, “Which politically for you guys it makes it kind of tough for you not to go for it.”
Commissioner’s Decision
Commissioner Overmyer clarified that the decision falls to the commissioners. At this time, and after hearing Dr. Holm’s feedback, he said he’d be inclined to approve participation in the program.