For Indiana State Senate District 23…

Elect Joshua Brant

Healthcare

  1. INTRODUCTION: Indiana benefits from access to high-quality medical professionals, advanced facilities, and ongoing medical innovation. However, many Hoosiers continue to face barriers related to affordability, accessibility, administrative complexity, and cost transparency. This proposal presents a state-focused healthcare reform framework for Indiana, informed by bipartisan policy discussions and adapted to remain within the legal authority of state government. It is not intended to replace federal law, but to improve healthcare affordability, accountability, and consumer protection for Indiana residents where state action is permitted.
  2. ROOT CAUSES: This plan recognizes that the problems with our current healthcare system is not the fault of any one person or group of people, and it seeks to spread the cost of repair as thin as possible. The purpose and scope of this section (II) is to identify all responsible parties from all affected perspectives, and to justify the culpability of those parties.
    1. Medical Insurance Companies
      1. Practices that may result in excessive pricing for essential medications or services, particularly where market competition is limited or consumer choice is constrained.
      2. Limiting patient options with private networks.
      3. Health Status Discrimination
      4. Financial incentives that may unintentionally encourage excessive claim denials or cost-containment strategies that negatively affect patient outcomes and quality of life.
      5. Denying claims or dropping policies based on administrative errors, unreasonable technicalities, and lack of prior notification, especially when prior notification is not a reasonable expectation.
      6. Determining a service or procedure is “unnecessary” at the advisement or council of someone within the insurance company, partnered with the insurance company, or otherwise not of the patient’s own choosing.
    2. The Drug Companies
      1. Inappropriate direct solicitation to doctors.
      2. Advertisements and other marketing practices drive up costs.
    3. Medical Billing
      1. Costs that are reasonably justifiable, passed on to the consumer, but could perhaps be reduced or partially offset by government aid:
        1. The costs of training and educating doctors and nurses.
        2. The costs of technology, medical research, and equipment.
      2. Costs that are unreasonable and/or unjustified:
        1. Unfair sterilization charges: Patients being charged for everything they come in contact with.
        2. Unfair hospitality charges: Bed costs at a hospital are outrageous. Consumers can often find cheaper beds at a five-star hotel in a major U.S. city.
        3. Unfair ambulance charges. It is understood that if a patient receives medical attention while in an ambulance, that they should pay for those services. However, the cost for transportation in an ambulance, especially if the patient is not in a position to reject transportation, is unreasonable.
      3. Other unfair billing practices.
        1. Undefined, unclear, or unstated pricing.
        2. A medical billing system based on quantity of tests and treatments rather than quality of service or resolution of customers problems. Unnecessary testing, procedures, or consultations are incentivized because they bring in more money. As it stands, there’s more money in treating symptoms than there is in curing or healing people. This is a consumer protection issue as well.
    4. The People
      1. Frivolous or exaggerated claims of entitlement against doctors and nurses. These suits drive up malpractice insurance costs, which in turn raises the costs of health care.
      2. People who skip out on, refuse to pay, or simply cannot pay their medical bills: The hospitals usually end up having to eat these costs or pass them on to their other patients.
      3. Young and generally healthy individuals are less likely to purchase health insurance when they perceive the immediate value to be low. This behavior can weaken risk pools and increase per‑enrollee costs, particularly in individual insurance markets. Historically, mandatory participation was used as one mechanism to address this imbalance. However, subsequent experience has shown that insurance markets can continue to function without compulsory enrollment, provided that plans offer sufficient value, transparency, and affordability to attract voluntary participation. Sustainable insurance markets should therefore rely on consumer value and informed choice rather than coercion, with insurers bearing responsibility for designing plans that are competitively priced, understandable, and responsive to consumer needs.
    5. The Government
      1. Historically, the prohibition of interstate commerce for insurance companies has limited competition, and in some cases even create monopolistic environments for consumers. The need for a marketplace was real, but initial execution left something to be desired.
      2. Additionally, both federal and state governments have used direct payments, tax advantages, risk corridors, and reinsurance programs to stabilize insurance markets. While these mechanisms were often justified as temporary measures to encourage market participation, insufficient transparency has made it difficult for taxpayers to evaluate whether such funds primarily reduced consumer costs or increased insurer profits. At the state level, Indiana policy must require full public accounting for any public funds or subsidies directed toward private insurers.
      3. Waste, Fraud, and Abuse related to Medicare and Medicaid.
      4. Political & campaign donations from insurance, pharmaceutical, and other special interest organizations.
  3. THE PEOPLE’S RESOLVE: These are the solutions to the problems identified in section two (II) of this proposal. They should be coupled with a prohibition on campaign/political donations from outside of Indiana and an amendment to Indiana rules on Corporate bylaws to prohibit political donations by corporations within the state (to be introduced in separate legislation).
    1. Medical Insurance Companies
      1. Maintain/Support the online marketplace to allow insurance companies to sell across state lines. This encourages competition amongst insurance companies, transparency, and helps consumers make informed decisions, especially in cases where transparency is required by law.
      2. Insurers must cover all medically necessary care.
      3. Insurers may not deny coverage based on medical status or preexisting conditions. However, incentives can be established to encourage a safer/healthier lifestyle, and premiums based on willful high-risk/unhealthy behaviors may be applied for whatever duration the behaviors continue.
      4. Insurers may not retroactively cancel coverage after a claim unless fraud is proven.
      5. Insurers must justify all claim denials and non-renewals with one or more of the following:
        1. Fraud
        2. Repeated Nonpayment
        3. Material misrepresentation
      6. If the patient’s doctor determines that the patient requires a medical procedure that could be considered elective, or is in excess of a defined threshold in the plan, the insurance company may require a second opinion, but it may not dictate which doctor the patient must see. If the original doctor was part of a private network required by the insurance company, then the insurance company has already expressed their confidence in the doctor, and they may not require a second opinion. Additionally, insurance companies must cover any costs incurred to obtain the second opinion upon proof of receipt.
      7. If the insurer is entitled to a second opinion, then so is the patient. Patients shall have the right to an external review of any claim-denial or non-renewal at their own expense.
      8. Penalties for unreasonable denials.
      9. Presumption of coverage for ambiguous claims: If policy language is unclear, the ruling defaults to the consumer.
      10. The insurance company may not dictate when the patient must obtain the second opinion, but they may deny a claim until which time a second opinion is obtained if the patient is reasonably able to do so.
      11. If the patient is physically unable to get to another doctor, the insurance company must bring the doctor to the patient if they want a second opinion.
      12. If the patient is unconscious or otherwise unable to choose their own doctor, all of the above provisions will defer to that person’s executor or legal caretaker.
    2. The Drug Companies
      1. Create and maintain an online marketplace for drug companies to provide data about their products to medical professionals in an open, ethical, and transparent way.
      2. Indiana shall condition participation in any state-administered marketplace, or publicly supported program, on compliance with advertising and disclosure standards established by the state, including limitations on promotional practices that materially increase consumer costs with the exception of permanent cures, life-saving treatments, and over the counter (OTC) medicines that consumer’s buy directly.
    3. Medical Billing
      1. Government Aid
        1. To help reduce the costs of education for doctors, create incentives for people to pursue medical degrees in general, and because it’s in the interest of society as a whole to have more qualified medical professionals, the state shall offer interest free loans to students actively working on their medical degree and maintaining at least a 3.0 GPA.
        2. To help offset the cost of medical technology and equipment used by the medical profession, any funding still being allotted to insurance companies that are not in compliance with transparency, consumer protection, and pricing disclosure standards set forth in this proposal shall be diverted to support medical facilities in maintaining & upgrading their equipment & technologies instead.
      2. The expectation, in return for the government aid mentioned above, is that the cost savings must be passed on to the patients, and that this must be enforceable by law.
        1. Price to the consumer for sterilization shall be limited to the documented marginal cost of sterilization, defined as:
          1. Labor time directly associated with sterilization,
          2. Sterilization materials and utilities,
          3. Equipment depreciation, attributable to sterilization, divided by the number of procedures performed during the same accounting period.
          4. Sterilization charges may not be used to offset unrelated operational, administrative, or capital expenses.
        2. Hospital room and facility fees shall be subject to a state-established maximum allowable charge, indexed annually to regional cost-of-living data & hospital operating costs, and publicly disclosed in advance of admission where practicable.
        3. Emergency medical transportation services shall be designated as essential public services, administered or contracted by local governments in a manner consistent with other emergency response systems. Medical staffing and clinical care may continue to be provided by private or nonprofit entities under standardized rate and service agreements.
      3. Other Unfair Billing Practices
        1. Medical billing shall be upfront, itemized, and not catch consumers off guard when able to be. When procedures or treatments are recommended to patients, those patients should be fully aware of the “costs” of those services, as well as any additional charges that may be incurred. They should be presented in verbal & written instructions as fluently to the patient as able.
        2. Indiana shall incentivize a transition from volume-based reimbursement to outcome- and quality-based reimbursement models by:
          1. Expanding bundled payments for common procedures
          2. Offering enhanced reimbursement for demonstrated reductions in hospital readmissions and medical errors
          3. Requiring public reporting of standardized quality metrics for state-licensed hospitals receiving public funds
          4. Participation in these programs shall be voluntary for providers, but participation shall be required for eligibility for any state-funded incentive or subsidy.
    4. The People
      1. Tort Reform: There are those among us who would take advantage of the very systems put in place to protect us. Indiana shall periodically review the impact of existing medical malpractice caps and procedural reforms on:
        1. Malpractice insurance premiums,
        2. Physician retention and recruitment, and
        3. Patient compensation outcomes.
        4. Any additional tort reform must be contingent upon demonstrable reductions in malpractice insurance costs, with a statutory requirement that such savings be passed through to patients via reduced service costs or insurance premiums.
        5. Nothing in this provision shall limit access to the courts for patients who experience legitimate medical negligence or reduce compensation for demonstrable harm.
      2. In an effort to dissuade those who can afford to pay their medical bills from simply skipping out on them, and to the extent permitted by federal law, unpaid medical debt may be reported to credit agencies only after a standardized notice period, income-based hardship review, and refusal or avoidance of the dispute resolution process. As long as the patient continues good-faith participation in the process, however, there may be no negative report on their credit.
      3. Upon stabilization of the individual insurance market and full implementation of the Public Option, outlined below, Indiana shall evaluate the feasibility of reducing employer insurance mandates for certain categories of employers, subject to workforce protections, federal law, and public health considerations.
      4. The People do not have an obligation to buy insurance, and there shall be no mandate from the state of Indiana. It is the responsibility of private firms, not the government, to create enough value to the consumer to warrant demand. Mandating the purchase of medical insurance has proven both unnecessary and contrary to the spirit of a free-market society.
    5. Government Policies
      1. Indiana shall, to the extent permitted by federal law, support and participate in mechanisms that facilitate increased competition in health insurance and pharmaceutical markets, including federally authorized interstate compacts, multi‑state marketplace arrangements, and reciprocal licensing or participation frameworks.
      2. The State may condition participation in any Indiana‑administered marketplace or publicly supported program on compliance with transparency, consumer protection, and pricing disclosure standards applicable to both in‑state and out‑of‑state participants. All other funding still being allotted to insurance companies shall be diverted to support medical facilities in maintaining and upgrading their equipment and technologies instead.
      3. The Indiana Legislature shall draft and sign into law a Claimant Bill of Rights, and establish a Fair Claims Review Board, a Good-Cause Non-Renewal Standard, and a Public Option Safety Net; all of which is to be included in the final version of this reform.
    6. Waste, Fraud, & Abuse in Medicare/Medicaid
      1. Nothing in this proposal authorizes non-patient parties to make end-of-life determinations. All medical decisions regarding life-sustaining treatment shall remain governed by patient consent, advance directives, and existing state and federal law.
      2. Medicare waste: While Medicare is a federally administered program beyond the direct control of the State of Indiana, the State nevertheless has a responsibility to address waste, fraud, and abuse occurring within Indiana’s healthcare system that impacts Medicare beneficiaries and taxpayers alike. Indiana shall cooperate fully with federal oversight authorities by:
        1. Requiring state-licensed healthcare providers and facilities to comply with enhanced billing transparency and documentation standards applicable to Medicare claims
        2. Supporting data sharing and audit cooperation with federal Medicare fraud prevention efforts
        3. Strengthening state-level penalties for fraudulent billing practices by providers operating within Indiana, regardless of payer source
        4. Indiana shall further seek to reduce Medicare-related waste indirectly by:
          1. Encouraging care coordination models that reduce duplicative testing and preventable hospital readmissions among Medicare patients
          2. Expanding voluntary participation in value-based care and bundled payment models for providers serving significant Medicare populations
          3. Supporting preventive care and chronic disease management programs that reduce long-term costs borne by Medicare
        5. Nothing in this section shall be construed to grant the State authority over Medicare eligibility, benefits, or reimbursement rates, which remain governed by federal law.
      3. Medicaid waste or fraud: Within the limits of federal law and subject to applicable waivers, Indiana Medicaid eligibility and continued participation may include the following requirements:
        1. Employment, education, job training, or active job search where legally permitted, and with reasonable exception to disabilities,
        2. Random drug testing, or substance abuse treatment in the event of a failed drug test,
        3. Periodic eligibility verification to reduce waste, fraud, and abuse,
        4. Annual income below 138% Federal Poverty Level (FPL), or children in households with an annual income below 150% of FPL,
        5. Legal citizenship or residency in the United States and primary residency in Indiana
  4. THE PUBLIC OPTION
    1. The Indiana Public Option shall be a state-administered, non-mandatory health insurance plan designed to serve individuals who are employed, self-employed, or actively seeking work, but who lack affordable access to private insurance.
    2. Key principles:
      1. Voluntary enrollment; no individual mandate
      2. Income-based premiums with transparent pricing
      3. Open to individuals not eligible for Medicaid or employer-sponsored insurance
      4. Administered by the state, with claims processed by competitively selected private administrators
      5. Provider reimbursement rates negotiated regionally to reflect Indiana cost realities
      6. The Public Option shall operate on a self-sustaining nonprofit model, with any surplus reinvested to reduce premiums or expand coverage.
  5. SEVERABILITY and LEGAL AUTHORITY
    If any provision of this proposal is found to exceed state authority or conflict with federal law, such provision shall be severed without affecting the remainder of the plan.

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