Op-ed: Hoosiers need Medicaid and that won’t change with a new administration

As Trump takes his second oath of office, we get closer to the possibility of Robert F. Kennedy and Dr. Mehmet Oz as our nation’s top public health officials. They’ll become the point people in charge of state Medicaid funding and policies. Like Indiana, the federal government will have some difficult budget decisions to make thanks to stagnating revenue.   

Republican tax cuts, mostly for the wealthy, continue to stress our budgets. Something will have to give as we approach an unsustainable level of national debt. Trump has declared cuts for Social Security and Medicare off-limits, but no similar promise has been made for Medicaid. It’s clear that federal funding for Medicaid is on the chopping block. Remember that the federal government foots around 70% of Indiana’s $19 billion bill. Over 2 million Hoosiers are on this growing health care program, and any significant changes could affect their access to care. Here are a couple of devastating cuts that could happen to the Medicaid program: 

 The first is block granting. The idea of block grant federal funding for Medicaid has existed since President Ronald Reagan's administration. With these grants, the government gives a fixed amount of funds based on inflation and population growth. This plan motivates states to contain costs, but it’s difficult to anticipate how much money Medicaid will need. Indiana would fare poorly under this plan since flat population growth and limited medical inflation would lead to a smaller grant. Our state would need to increase its share of funding to maintain the status quo. We can forget any additional enhancements like more waiver slots or the coverage of GLPs for weight loss. Block granting hasn’t gone anywhere for forty years, but with Trump returning to office this could be a reality. 

Second is the sunsetting of programs that fund our HIP program and supplements for eldercare assistance. If federal support is drastically reduced, the HIP program will end unless state dollars fund it entirely. 

The third is the recategorization of mandatory services. Medicaid currently has two general types of services covered: mandatory and optional. Mandatory services include hospital visits, doctor appointments and outpatient services. Optional services include dental, physical therapy and prescription drugs. To cut costs, mandatory services could be recategorized and covered at a reduced rate. This would be devastating to Hoosiers and providers since it lowers their reimbursements. Indiana already has shortages of care, and one can only imagine what would happen if the required provisions for Medicaid changed. 

 Fourth is the creation of work requirements, and a bill has already been filed for this session. Indiana attempted to implement work requirements last year, but it was blocked by the Biden Administration. 

Fifth is watering down the federal pledge to fund 90% of the Affordable Care expansion. This could also spell the end of Indiana’s HIP program that supports thousands of Hoosiers. 

It’s pitched as an effort to save costs, but thousands would lose their coverage. Over 500,000 Hoosiers would potentially lose health care coverage. Uncompensated coverage would shift the cost to hospitals and providers. Fewer people will go to the doctor and those with existing conditions will worsen trying to avoid enormous medical bills.  

National decisions will have an impact on Hoosier health and our Medicaid program. We’ve been blessed with infusions of federal dollars since COVID-19. Indiana is already struggling without the extra funding, and the prospect of funding reductions will only aggravate our predicament. The majority party leaders have been open with their desire to cut funding, saying our current allocation “keeps them up at night.” At the December Medicaid forecast, the same leadership said our funding challenge “scared them.” Even if federal cuts don’t happen, Indiana’s state funding will need to increase by $500 million.

Every dollar is attached to a person, and we cannot cut more. The supermajority has cut services for medically compromised children, vulnerable adults and families in need of child care. Indiana has saved a minimal amount with horrendous consequences and unnecessary pain. I sincerely hope that efforts to curtail costs will not be cut focused. We have other options, including creatively expanding our revenue, to adequately fund Medicaid. 

We could increase the cigarette tax by $2 per pack. This would add over $100 million a year to our revenue. Another element is promising to stop reverting Medicaid appropriations to the general fund. This has been done for the past several years. We could also fully consider maximizing any unrealized federal funding opportunities that we’re not using. The window is closing to implement these changes before it’s too late. I have seen the legislature act quickly in the past to provide tax relief, so I know it can be done if we have the will to act. 

This session, let’s protect Medicaid and preserve Indiana’s essential health infrastructure. Let's protect Medicaid since it's a vital program for one in three Hoosiers. Let’s lead by example and show other states we’re up to the Medicaid funding challenge. Let’s eliminate our health care deserts. Indiana can become a health care oasis for all Hoosiers regardless of income or health conditions.

Porter: ‘Indiana’s revenue reports are no longer defying gravity’

Today, Dec. 17, the State Budget Committee met to discuss the final revenue forecast before the 2025 legislative session. State Rep. Gregory W. Porter (D-Indianapolis) released the following statement regarding the forecast: 

“Unlike the hit Broadway musical and blockbuster movie ‘Wicked,’ Indiana’s revenue expectations are no longer defying gravity. We’ve utilized our COVID-19 stimulus money, and we’re nearing the end of robust growth in the economy. Our revenues are resetting to relatively normal, sustained growth. 2025 looks promising since aid from the Federal Reserve will give our economy a soft landing. We’ll start to see inflation dissipate and hiring will remain strong. However, by 2026 we’ll see muted growth that will get worse in 2027. 

“Keep in mind this forecast may change dramatically in April. If the Trump administration imposes its tariffs, the Federal Reserve will slow its interest rate reductions as inflation rises. Due to the potential for change, I recommend we discuss the April forecast in March. We’ll need an extra month to assess these changes before the end of the budget session. We need to be watchful for these revenue fluctuations and prepare to modify the 2025 budget. 

“$23 billion for predicted revenue is great, but this will be tempered by human infrastructure needs. Our predicted revenue may not be enough to cover Medicaid’s needs or provide more than a 1% increase in K-12 funding. To make matters worse, Indiana is actively losing usable revenue from cuts in the state income tax. We’re losing hundreds of millions of dollars per year for cuts that may save Hoosiers $50. 

“It’s promising that our revenue is climbing, but there are storm clouds on the horizon. We need to constantly monitor our revenue, remain flexible and stay vigilant. I hope we follow through with my recommendation to discuss the April forecast a month early, so Indiana can craft the best budget possible for Hoosiers.” 

Porter comments on Braun’s misguided tax proposal

State Rep. Gregory W. Porter (D-Indianapolis) released the following statement regarding Gov.-elect Mike Braun’s tax plan: 

“It’s clear that Braun’s tax plan was designed to provide further benefits to wealthy Hoosiers. I haven’t seen any legislative proposals, but I’m highly concerned with the plan’s contents. My major concern is the two-year state income tax credit for those bumped into higher tax brackets due to inflation, the so-called ‘Bidenflation Relief Tax Credit.’

“Braun believes federal taxes are slamming Hoosiers, and we can soften the impact with Indiana’s tax code. Frankly, this idea is misguided and fiscally unsound. In 2022, we addressed a federal change by tying state and federal fiscal tax policy together. We’re still experiencing inconsistent revenue flows from that decision. 

“It’s a dangerous game to link these two systems together. We’re comparing apples to oranges. Indiana has a flat tax rate. Everybody is taxed at 3.05% whereas the federal percentage changes based on your income level. 

“Besides, addressing inflation isn't a novel idea. Most of Hoosier’s federal taxes are already calculated with inflation in mind thanks to the 1981 Economic Recovery Tax Act (ERTA). It’s passive income streams for higher tax brackets, like stock investments, where there will be real benefits. The better option is to make the state-earned income tax credit more reflective of the federal amount. This would benefit lower to moderate-income taxpayers who don’t have passive incomes.  

“The bottom line is this proposal will divert our limited state income tax revenue to the wealthiest taxpayers. Middle- and working-class families will get no relief. Indiana’s human infrastructure needs, like childcare and K-12 public funding, will be even more strapped for cash. We should shelve this proposal from further consideration and create something that truly helps the average Hoosier.”

Porter disappointed in SALTR report, says changes are handouts to big businesses

Today (Nov. 20),  the State and Local Tax Review Task Force (SALTR) voted on their final report and recommendations. The report includes eliminating the 30% personal property tax floor and the implementation of cuts to the local income tax, which will result in $1 billion in lost revenue by 2030. 

State Rep. Gregory W. Porter (D-Indianapolis) released the following statement: 

“This report is a nothingburger that provides no solution to rising property tax rates. In fact, Republicans will give big businesses even more handouts by changing the de minimis business personal property tax and the 30% floor on depreciable personal property. The state will lose $289 million in revenue, which will shift the burden to the very homeowners we’re trying to help. 

“By cutting the amount we receive from businesses, we’re putting more burden on property taxes to make up the difference. Local schools, EMS services and other entities will need the funding from somewhere, and it will be out of working-class families already emptied pockets. 

“This task force was established to create more effective controls for property taxes and help working Hoosiers afford their bills so they could stay in their homes. I believe these recommendations will do the opposite. I simply cannot square the circle on the disparate property tax provisions in this report. 

“A couple of the task force’s thoughts on the Local Income Tax (LIT) are well-informed. It’s prudent public policy to use GIS data for LIT distributions and to allow cities to adopt their own LIT. As for the idea of reducing the overall LIT cap to match the state income tax, I'll reserve my judgment for a later date.

”I’m disappointed in this report which provides very little relief to hard-working Hoosiers. We can do better for our homeowners, and we should do better.”