By Mike Ripley, vice president of health care policy and employment law
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Despite this being a budget year, legislators could not be convinced to raise the cigarette tax. Nor could they be swayed to increase the legal age to 21 on tobacco products, contrary to the pre-session remarks by legislative leaders. Not to mention, more than 60% of Hoosiers favor a cigarette tax increase and raising the legal smoking age to 21.
This marks the third consecutive session that legislators have completely failed to take any action to significantly reduce Indiana’s high smoking rate.
Nearly 22% of Hoosier adults smoke, ranking Indiana 44th worst among the 50 states. That high smoking rate leads to a variety of expensive illnesses and premature deaths. It costs our businesses $6.2 billion a year in increased health care expenditures and lost productivity.
Legislators couldn’t even come to an agreement for a tax on vaping products – many of which contain nicotine. It’s become a real crisis among young people in our middle and high schools. For most of the session, this effort (HB 1444) looked like the one bright spot, but it came to a screeching halt at the very end of session. The Chamber, along with the Alliance for a Healthier Indiana, had to oppose the final conference committee report version because it had been neutered to where there was no significant impact on vaping. It was a 5% retail excise tax on e-liquids but not the devices. That’s a far cry from the 20% retail excise tax on e-cigarette products that cleared the Senate Appropriations Committee 12-1.
If we had supported a 5% tax, it would not curb the youth vaping epidemic, and it would be a number of years before we could get another increase. I want to thank the following for their hard work despite the outcome: Julie Halbig and Laura McCaffrey of the Indiana Hospital Association, Bryan Hannon of the American Cancer Society, Tori Castor of IU Health, Anne Murphy of Community Health Network and Grant Achenbach of the Indiana State Medical Association.
We acknowledge the complexities – do you equitably tax e-cigarettes on par with tobacco products, at retail, wholesale or on the nicotine itself – but legislators essentially punting on this issue by agreeing on a worthless policy is worse than doing nothing. And it’s an insult to the parade of educators and administrators who testified in the hearings about how bad the vaping situation has gotten in such a short period of time in Hoosier schools. There needs to be sufficient tax on Juul pods, which is what is driving teenage e-cigarette usage and accounts for the majority of e-cigarette-related sales. Maybe next session legislators will think more about the health of our youth instead of listening to the lobbying efforts from Juul and convenience stores.
Pharmacy Benefit Managers, Opioids, Marijuana and More
The pharmacy community pushed hard this session to pass legislation that would have regulated pharmacy benefit managers (PBMs). Representative Martin Carbaugh (R-Fort Wayne) authored HB 1180 that we felt over regulated PBMs. But as it came out of the House, the bill was a study committee on PBMs and something we could support. However, the version that Sen. Travis Holdman (R-Markle) sponsored and passed in the Senate was over regulation on steroids. The Chamber stayed out of the detailed discussions to allow the pharmacy side and the PBM side to work out their differences.
In conference committee, we were asked to flex our Chamber muscle and be the lead on how PBMs are used by employers (to help control prescription drug costs). In the end, Rep. Carbaugh put the study language on PBMs, along with a provision that PBMs had to publish the maximum allowable cost list every seven days, instead of the current longer time frame of once every 30 or 60 days, into HB 1588.
With a month left in the session, the Chamber and its subsidiary, the Wellness Council of Indiana, learned that the Employee Substance Abuse Treatment Program guidelines passed in legislation last year inadvertently prohibited about 80% of employers and employees from fully participating. That’s because it included a requirement to not have an employer assistance program (EAP). That meant companies with EAPs would not be able to receive the important civil immunity protection for a negligent hiring. The Chamber approached the author of the 2018 legislation, Rep. Steve Davisson (R-Salem), and asked him to include a provision in one of his bills that eliminated the requirement of not having an EAP.
Representative Davisson readily agreed to put that language in HB 1246 (Pharmacy Matters). However, later on in the session he made an attempt to put PBM language that the Chamber opposed in that same bill. We told Rep. Davisson if that happened, we would work to kill the bill despite our desire to open up the substance abuse guidelines program to more employers. Thanks to Rep. Cindy Kirchhofer (R-Beech Grove) and a significant fiscal impact to the state, that PBM language failed to be included in the final conference committee report. Kudos are deserved for Rep. Davission, too, who could have been upset with our move to kill that language yet kept his promise and passed the fix. Now any employer who fully participates in the outlined actions in the guidelines and implements a standardized system will be eligible for the legal protection.
House Bill 1344 (Nurse Licensure Compact), authored by Rep. Ed Clere (R-New Albany) is an important policy for the southern part of the state and Chamber member Hosparus Health. It allows for nurses to practice in Indiana and Kentucky, thereby addressing a workforce shortage in nursing among facility providers in the Louisville corridor. Chamber Health Care Policy Committee member Amelia McClure from Hosparus Health worked hard to help make this happen.
Senate Bill 176 (Prescriptions), authored by Sen. Ron Grooms (R-Jeffersonville) requires providers to prescribe controlled substances electronically beginning January 1, 2021.
Senate Bill 575 (Hospitals), authored by Sen. Ed Charbonneau (R-Valparaiso), changes hospital licensure from the current one year to two years beginning May 1, 2020. It also included interim study language on hospital licensure, current structure, types of hospitals and classifications and subclassifications through the hospital’s license.
Senate Bill 162 (Chronic Pain Management), authored by Sen. Mark Messmer (R-Jasper), requires state employee health plans, Medicaid, policies of accident and sickness insurance, and health maintenance organization contracts to provide coverage for medically necessary chronic pain management. The bill defines chronic pain management as evidence-based health care products and services prescribed by a physician to relieve pain that has lasted for at least three months. The term includes prescription drugs, physical therapy, occupational therapy and chiropractic care.
And finally, one issue that received a lot of attention during the interim leading up to session was the legalization of medicinal marijuana. A dozen or more similar bills were filed but none of them gained even a hearing. Legislative leaders and the Governor have expressed no desire in going down that road. And the Chamber has and will continue to advocate against medical marijuana, as well as recreational, as long as it is deemed illegal by the federal government.
Resource: Mike Ripley at (317) 264-6883 or email: [email protected]