Deadlines spur big changes to Indiana bills on hospital prices, 13th checks, road funding

Yahoo

11-04-2025

Sen. Chris Garten, R-Charlestown, discusses an amendment to House Bill 1004 in committee on April 10, 2025. (Whitney Downard/Indiana Capital Chronicle)
Bills throughout the Indiana Statehouse took on hefty rewrites Thursday as end-of-session deadlines loomed.
A health care measure now freezes certain hospital prices; 13th checks were stripped from Hoosier retirees, at least for now; and bipartisan changes were approved to other bills dealing with homelessness and college scholarships. A major road funding bill took new shape, as well.
Thursday marked the last day for bills to advance from committees. Floor amendments in both the House and Senate must be approved by end-of-day Monday in time for final chamber votes on Tuesday.
After that, any other bill negotiations will be hashed out in conference committees — largely behind closed doors — before the last week of April, when the legislature is required to wrap up.
Introducing a lengthy amendment, Sen. Chris Garten told the Senate Appropriations Committee, on which he sits, that the majority caucus would be pivoting away from the 'price caps' under House Bill 1004 to a two-year price freeze for the state's five largest nonprofit hospital systems. During the first year, analysts with the state's Office of Management and Budget would conduct a hospital pricing study to provide an independent review.
By 2027, with a new average price benchmark identified, hospitals could then be penalized for exceeding that cost — similar to the original version that used a percentage of Medicare prices as its standard.
Accrued fees will be deposited into an account to offset the state's Medicaid costs. By 2029, violators could lose their nonprofit, tax-exempt status.
'We're creating a four-year runway. We're trying to ease into this and we want to make sure we do this with the hospitals, and so there's been an immense amount of collaboration on that part of it,' said Garten, R-Charlestown.
Additionally, the mandated physician reimbursement will now be 168% of the Medicare rate and hospitals directly contracting with employers, bypassing insurers, would have a price cap.
While the above portions '(try) to get hospitals back in line to help lower health care costs,' other parts 'help hospitals,' Garten said, specifically rural health systems.
Insurers must disclose fees and commissions to clients in total dollars, not as a percentage, with potential consequences for noncompliance. Third party administrators will also have transparency requirements.
Rep. Martin Carbaugh, who authored the underlying bill, said that as an insurance broker himself, the disclosure 'doesn't scare me at all.'
'I think if you're scared of disclosing how much you make, it might be part of the problem,' said Carbaugh, R-Fort Wayne.
Hospitals will also be prohibited from contracting with insurers that don't decouple their Medicare Advantage plans from commercial options — requiring separate negotiations.
'Right now, hospitals are taking a massive, massive loss on Medicare Advantage plans in their contract negotiations,' Garten said. '… I've heard from dozens of rural systems that said, 'If we could get this done, it would be one of the largest helps.''
I think if you're scared of disclosing how much you make, it might be part of the problem.
– Rep. Martin Carbaugh, R-Fort Wayne
The bill retained language restructuring of the Hospital Assessment Fee to leverage larger reimbursements from the federal government.
But not everyone appreciated the changes.
'… We're putting a price tax on only one industry in the state of Indiana (and) saying, 'You can't raise your prices for the next few years. It doesn't matter what the environment is,'' said Sen. Liz Brown, R-Fort Wayne. ''It doesn't matter if you have another pandemic. It doesn't matter if the tariffs increase all the costs of services and goods that come into your hospital system — you can't raise your prices for the next two years. Period.''
Brown pointed to Congressional uncertainty, specifically around Medicaid. Federal dollars make up roughly one-third of the state's Medicaid budget.
'I just can't even fathom that we did this,' Brown said.
Brown joined three Democrats to oppose the bill. One Democrat, Sen. Lonnie Randolph of East Chicago, joined Republicans to advance the proposal.
Within a new, wide-reaching amendment to House Bill 1461, Rep. Jim Pressel's road funding proposal, are changes to a debated wheel tax that would now allow some Hoosiers to be taxed twice.
The Senate panel reverted the legislation to an earlier version, in which 'stacked' wheel taxes can be imposed by cities or towns, as well as the county in which they're located.
Language in the bill requires local governments to adopt a wheel tax to qualify for state grant funds, despite opposition from municipal officials.
The latest road funding draft also promises up to $50 million per year to Indianapolis 'for use on secondary streets,' as long as the city matches those funds.
Brown questioned why taxpayers across the state should be burdened with maintaining Indianapolis' roads 'when our own communities are funding those things on our own.'
'Is that our problem to solve?' she asked. 'For us to double down on this community … I'm kind of struggling. … We are rewarding them by giving them extra money.'
Pressel noted that Indianapolis 'has a $680-million-a-year road funding problem. 'And if we don't help them and encourage them to spend their dollars correctly,' he said, 'that problem is not going to go away on its own.'
'They are never going to be able to catch up — unless we want to take back roads, put that back under the state's purview,' he continued. 'I struggle with it too, but if we don't take the initiative, I don't know what else to do. … It's our capital city, and we should help them move in the right direction.'
Also included are increased registration fees for electric vehicles from $150 to $340, and from $50 to $170 for hybrids. Baked in, too, is a provision to raise the speed limit on I-465, which circles Indianapolis, from 55 mph to 65 mph.
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The bill advanced to the chamber floor in a 9-4 vote.
The Senate committee also struck out a four-year 13th check from House Bill 1221. The annual bonus check has been used in the past to help public sector retirees with increasing costs.
But Senate budget leader Sen. Ryan Mishler, R-Mishawaka, suggested that checks would be part of further budget discussions.
Earlier bill language ensured a two-year traditional 13th check for current retirees until an automatic 1% cost-of-living adjustment takes effect in 2027.
'While we're disappointed the 13th check for the next two years is no longer included in HB 1221 because we were hoping to put this issue to bed early this year, we are optimistic that the 13th check will make it into the final version of the budget,'said Jessica Love, executive director of the Retired Indiana Public Employees Association.
Appropriations committee member Sen. Greg Goode, R-Terre Haute, said to 'trust in the process.'
Love said Hoosier retirees are 'trying to do the same.' For now, she said, supplemental reserve accounts 'have more than enough funding' to cover the cost of 13th checks — ranging from $150 to $450 — through the biennium.
'Retirees continue to desperately need this type of benefit enhancement approved for the next two years, especially without a more meaningful or permanent solution in place,' Love added. 'So, while the budget process is a complicated one, that fact should make the 13th check decision an easy one, and we look forward to a positive outcome by the end of session.'
In the House, Democrats begrudgingly offered amendments to compromise, at least somewhat, on two additional measures.
The first — a bill addressing homelessness — was softened to limit the instances when unhoused Hoosiers can be charged with a crime.
Provisions in Senate Bill 197 stipulate that 'a person may not camp, sleep, or use for long term shelter a public right-of-way or public land unless authorized for that use by the state or political subdivision, as appropriate.'
Those who have not moved from a public right-of-way within 24 hours of a law enforcement officer's warning — or from public land within 72 hours — could be arrested and charged with a Class C misdemeanor. The charge carries a maximum penalty of 60 days in jail or a $500 fine.
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Limitations were added Thursday, though, to require that a person refuse multiple forms of housing and other intervention services offered by law enforcement or crisis management teams before an arrest can be made.
The effective date on the proposal was additionally pushed back a year, to July 1, 2026, which Democratic Rep. Justin Moed said 'will give communities, law enforcement, service providers, some more time to try to get ready and prepare for this new law.'
'This bill isn't perfect, and there isn't really a soundbite or a cute newspaper article that you can get out of this,' said Moed, of Indianapolis. 'Life on the street is complicated, and the reasons that people are there are various — and the ways in which we can reach them is varied, as well. It's easy to cast judgment, and it's easy to imagine that if we were there, that we would choose some different way.'
'What we really need is more supportive services,' he continued. 'We need more compassion.'
Scholarship eligibility changes were separately made within Senate Bill 289, a GOP-backed 'anti-discrimination' measure.
The underlying bill prevents state-funded scholarships intended only for minority students, like the Next Generation Hoosier Educators Scholarship; the William A. Crawford minority teacher scholarship; and the Earline S. Rogers student teaching scholarship for minority students.
Rather than eliminate those awards altogether, lawmakers approved new requirements to allow all Hoosier students in five 'underserved' areas — Allen, Marion, Lake County, St. Joseph and Vanderburgh counties — to apply.
Rep. Earl Harris Jr., D-East Chicago, said the amendment ensures that minority students would still have the opportunity to apply for those scholarships and other financial aid.
'In a perfect world, I wouldn't be standing here offering this amendment,' Harris said. 'Do I want to make changes to the scholarships that are named after three former legislators? No. But we're in a position where the options are (either) those go away, or the option to take here, which is to modify them. … But we don't want to cause hundreds of students to lose money, so this will at least keep something in place.'
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