IN Focus: Implementing the Affordable Care Act

>>> PRODUCTION SUPPORT FOR THIS EPISODE OF “INFOCUS” IS PROVIDED EPISODE OF “INFOCUS” IS PROVIDED BY: HOOSIER ENERGY, PROVIDING BY: HOOSIER ENERGY, PROVIDING ELECTRICITY TO CENTRAL AND ELECTRICITY TO CENTRAL AND SOUTHERN INDIANA ELECTRIC SOUTHERN INDIANA ELECTRIC COOPERATIVES AND THEIR MEMBERS COOPERATIVES AND THEIR MEMBERS AND BY WTIU MEMBERS AND BY WTIU MEMBERS THANK YOU! THANK YOU! >> FOLLOWING REELECTION OF >> FOLLOWING REELECTION OF PRESIDENT BARACK OBAMA AND THE PRESIDENT BARACK OBAMA AND THE RETENTION OF A DEMOCRATIC RETENTION OF A DEMOCRATIC MAJORITY IN THE UNITED STATES MAJORITY IN THE UNITED STATES SENATE, THE REPEAL OF THE SENATE, THE REPEAL OF THE AFFORDABLE CARE ACT IS UNLIKELY AFFORDABLE CARE ACT IS UNLIKELY THAT MEANS INDIANA WILL HAVE TO THAT MEANS INDIANA WILL HAVE TO DECIDE WHETHER THEY SET UP THEIR DECIDE WHETHER THEY SET UP THEIR OWN HEALTHCARE EXCHANGE OR ALLOW OWN HEALTHCARE EXCHANGE OR ALLOW THE FEDERAL GOVERNMENT TO SET THE FEDERAL GOVERNMENT TO SET ONE UP FOR THEM ONE UP FOR THEM WE WILL LOOK AT THIS WE WILL LOOK AT THIS IMPLEMENTATION OF HEALTHCARE IMPLEMENTATION OF HEALTHCARE REFORM, “INFOCUS.” REFORM, “INFOCUS.” ś >> AND THANKS FOR JOINING US FOR >> AND THANKS FOR JOINING US FOR THIS EDITION OF “INFOCUS.” THIS EDITION OF “INFOCUS.” I’M STAN JASTERZEBSKI I’M STAN JASTERZEBSKI THE AFFORDABLE CARE ACT, IT THE AFFORDABLE CARE ACT, IT GIVES STATES THE OPTIONS TO GIVES STATES THE OPTIONS TO EXPAND THE MEDICAID COVERAGE AND EXPAND THE MEDICAID COVERAGE AND AS WTIU GRETCHEN PHRASY HAS — AS WTIU GRETCHEN PHRASY HAS — FRAZEE, INDIANA HAS TAKEN A FEW FRAZEE, INDIANA HAS TAKEN A FEW STEPS ON THIS LAW STEPS ON THIS LAW >> THE MOST PRESSING ISSUE IS >> THE MOST PRESSING ISSUE IS SETTING UP A HEALTHCARE EX SETTING UP A HEALTHCARE EX CHANGE CHANGE THIS IS THE STATE HEALTHCARE THIS IS THE STATE HEALTHCARE REFORM LEAD REFORM LEAD SHE SAYS EXCHANGES ARE BASICALLY SHE SAYS EXCHANGES ARE BASICALLY ONLINE DATABASES WHERE PATIENTS ONLINE DATABASES WHERE PATIENTS WOULD BE ABLE TO SHOP FOR THE WOULD BE ABLE TO SHOP FOR THE BEST HEALTH INSURANCE BEST HEALTH INSURANCE >> THINK OF IT AS AN EXPEDIA ORR >> THINK OF IT AS AN EXPEDIA ORR AN AN ORBITZ WHERE YOU CAN AN AN ORBITZ WHERE YOU CAN COMPARE COST AND QUALITY AND COMPARE COST AND QUALITY AND THEN MAKE YOUR PURCHASING THEN MAKE YOUR PURCHASING DECISION DECISION >> THE STATES MUST DECLARE THIS >> THE STATES MUST DECLARE THIS MONTH IF THEY WANT TO SET UP MONTH IF THEY WANT TO SET UP THEIR OWN EXCHANGE, IF THEY WANT THEIR OWN EXCHANGE, IF THEY WANT TO PARTNER WITH THE FEDERAL TO PARTNER WITH THE FEDERAL GOVERNMENT, THEY MUST DECIDE GOVERNMENT, THEY MUST DECIDE THAT BY FEBRUARY, OR ELSE THE THAT BY FEBRUARY, OR ELSE THE FEDERAL GOVERNMENT WILL STEP IN FEDERAL GOVERNMENT WILL STEP IN PRIOR TO HIS ELECTION PRIOR TO HIS ELECTION GOVERNOR-ELECT MIKE PENCE SAID GOVERNOR-ELECT MIKE PENCE SAID HE DID NOT WANT TO SET UP AN HE DID NOT WANT TO SET UP AN EXCHANGE EXCHANGE >> I BELIEVE WE SHOULD NOT >> I BELIEVE WE SHOULD NOT IT’S A DEEPLY FLAWED BUREAU’SY IT’S A DEEPLY FLAWED BUREAU’SY IS AND MY COMPETITOR’S IDEA, THE IS AND MY COMPETITOR’S IDEA, THE FEDERAL GOVERNMENT USUALLY FEDERAL GOVERNMENT USUALLY PARTNERS WITH STATES THE WAY AN PARTNERS WITH STATES THE WAY AN ALLIGATOR PARTNERS WITH A DUCK ALLIGATOR PARTNERS WITH A DUCK >> WE NEED TO MOVE ON >> WE NEED TO MOVE ON >> WE WILL NOT BE WINNERS IN THE >> WE WILL NOT BE WINNERS IN THE HYBRID, WE WILL BE LOSER HYBRID, WE WILL BE LOSER >> AND PENCE HAS MAINTAINED THAT >> AND PENCE HAS MAINTAINED THAT VIEW VIEW BESIDES THESELF CHANGE, THERE’S BESIDES THESELF CHANGE, THERE’S THE MEDICAID EXPANSION THE MEDICAID EXPANSION THEY HIRED AN CULTANT TO FIND THEY HIRED AN CULTANT TO FIND OUT HOW MUCH THE MEDICAID OUT HOW MUCH THE MEDICAID EXPANSION COULD COST EXPANSION COULD COST IT COULD COST $1.7 BILLION OVER IT COULD COST $1.7 BILLION OVER SEVEN YEARS IF EXTENDS COVERAGE SEVEN YEARS IF EXTENDS COVERAGE TO ANYONE WHOSE INCOME IS AT OR TO ANYONE WHOSE INCOME IS AT OR BELOW THE FEDERAL POVERTY LIMIT BELOW THE FEDERAL POVERTY LIMIT BUT IF THE STATE DOES NOT EXPAND BUT IF THE STATE DOES NOT EXPAND ITS OFFERINGINGS COSTS WOULD STL ITS OFFERINGINGS COSTS WOULD STL GO UP ABOUT $600 MILLION BECAUSE GO UP ABOUT $600 MILLION BECAUSE OF CHANGES THE AFFORDABLE CARE OF CHANGES THE AFFORDABLE CARE ACT MADE TO MEDICARE ON A ACT MADE TO MEDICARE ON A FEDERAL LEVEL FEDERAL LEVEL >> THERE WILL BE PROMOTION OF >> THERE WILL BE PROMOTION OF THIS BY THE FEDERAL GOVERNMENT THIS BY THE FEDERAL GOVERNMENT AND HEALTH INSURANCE EXCHANGES, AND HEALTH INSURANCE EXCHANGES, AND BY ADVOCACY GROUPS, AND BY ADVOCACY GROUPS, INDIVIDUALS WHO WILL HEAR ABOUT INDIVIDUALS WHO WILL HEAR ABOUT THE NEED TO HAVE HEALTH THE NEED TO HAVE HEALTH INSURANCE AND THE MANDATES TO INSURANCE AND THE MANDATES TO HAVE HEALTH INSURANCE, AND WHILE HAVE HEALTH INSURANCE, AND WHILE THAT MANDATE MAY OR MAY NOT THAT MANDATE MAY OR MAY NOT APPLY TO THEM, THEY WILL PRESENT APPLY TO THEM, THEY WILL PRESENT THEMSELVES TO IDENTIFY IF THEY THEMSELVES TO IDENTIFY IF THEY ARE ELIGIBLE OR NOT ARE ELIGIBLE OR NOT >> THE SUPREME COURT DECISION >> THE SUPREME COURT DECISION MADE THEEL PASSION OEXPANSION OD MADE THEEL PASSION OEXPANSION OD OPTION AND THERE’S NO SET TIME OPTION AND THERE’S NO SET TIME FRAME FRAME BUT THIS MAY BE BENEFITS TO BUT THIS MAY BE BENEFITS TO IMPLEMENTING IT EARLIER RATHER IMPLEMENTING IT EARLIER RATHER THAN LATER THAN LATER >> THE FIRST THREE YEARS ARE >> THE FIRST THREE YEARS ARE 100% FEDERALLY MATCHED 100% FEDERALLY MATCHED HOWEVER, THAT IS ACTUALLY NOT HOWEVER, THAT IS ACTUALLY NOT DEFINED AS FIRST THREE YEARS OF DEFINED AS FIRST THREE YEARS OF WHEN THE STATE DECIDES TO EXPAND WHEN THE STATE DECIDES TO EXPAND BUT ACTUALLY FIRST YEAR, BUT ACTUALLY FIRST YEAR, CALENDAR YEAR 2014, ’15 AND ’16 CALENDAR YEAR 2014, ’15 AND ’16 >> SO THEY WILL NOT RECEIVE AS >> SO THEY WILL NOT RECEIVE AS MUCH FEDERAL FUNDING AS THEY MUCH FEDERAL FUNDING AS THEY WOULD HAVE, IF THEY EXPANDED WOULD HAVE, IF THEY EXPANDED RIGHT AWAY RIGHT AWAY DR. ROB STONE IS THE FOUNDER OF DR. ROB STONE IS THE FOUNDER OF HOOSIERS FOR A COMMON SENSE HOOSIERS FOR A COMMON SENSE HEALTHCARE PLAN HEALTHCARE PLAN HE SAYS EVEN THOUGH SOME DOCTORS HE SAYS EVEN THOUGH SOME DOCTORS MAY NOT WANT TO ACCEPT MORE MAY NOT WANT TO ACCEPT MORE MEDICAID PATIENTS, IT’S TOO GOOD MEDICAID PATIENTS, IT’S TOO GOOD OF A DEAL FOR THE STATE TO PASS OF A DEAL FOR THE STATE TO PASS UP UP >> IT’S STILL CLEARLY BEEN >> IT’S STILL CLEARLY BEEN PROVEN TO BE BETTER THAN NO PROVEN TO BE BETTER THAN NO COVERAGE AT ALL COVERAGE AT ALL IT HELPS PEOPLE GET BETTER CARE IT HELPS PEOPLE GET BETTER CARE IT HELPS PEOPLE BE HEALTHIER IT HELPS PEOPLE BE HEALTHIER IT IMPROVES THE HEALTH OF OUR IT IMPROVES THE HEALTH OF OUR WORKFORCE IN INDIANA WORKFORCE IN INDIANA IT HAS MUCH BROADER ECONOMIC IT HAS MUCH BROADER ECONOMIC IMPLICATIONS THAN JUST THE FACT IMPLICATIONS THAN JUST THE FACT THAT IT WOULD BE FEDERAL MONEY THAT IT WOULD BE FEDERAL MONEY COMING INTO THE STATE THAT WE COMING INTO THE STATE THAT WE WOULDN’T GET OTHERWISE WOULDN’T GET OTHERWISE >> INDIANA IS CONSIDERING >> INDIANA IS CONSIDERING ALTERNATIVES, AND IT HAS ITS OWN ALTERNATIVES, AND IT HAS ITS OWN PROGRAM CALLED THE HEALTHY PROGRAM CALLED THE HEALTHY INDIANA PLAN THAT PLOYS INDIANA PLAN THAT PLOYS ADDITIONAL SUBSIDIES TO ADDITIONAL SUBSIDIES TO LOW-INCOME HOOSIERS BUT THEY LOW-INCOME HOOSIERS BUT THEY ALSO HAVE TO PAY INTO THE PLAN ALSO HAVE TO PAY INTO THE PLAN THAT MEANS IT TENDS TO COST THE THAT MEANS IT TENDS TO COST THE STATE LESS MONEY THAN STATE LESS MONEY THAN TRADITIONAL MEDICAID TRADITIONAL MEDICAID INDIANA HAS APPEALED TO THE INDIANA HAS APPEALED TO THE FEDERAL GOVERNMENT TO ASK IF AN FEDERAL GOVERNMENT TO ASK IF AN EXPANDED STATE PLAN WOULD EXPANDED STATE PLAN WOULD QUALIFY FOR THE SAME FEDERAL QUALIFY FOR THE SAME FEDERAL ASSISTANCE AS MEDICAID ASSISTANCE AS MEDICAID EXPANSION EXPANSION THE FEDERAL GOVERNMENT HAS NOT THE FEDERAL GOVERNMENT HAS NOT YET PROVIDED AN ANSWER

YET PROVIDED AN ANSWER >> AND WE ARE JOINED IN STUDIO >> AND WE ARE JOINED IN STUDIO BY NANCY JEWELL, THE PRESIDENT BY NANCY JEWELL, THE PRESIDENT OF THE INDIANA MINORITY HEALTH OF THE INDIANA MINORITY HEALTH COALITION, ALSO MARK MOORE, THE COALITION, ALSO MARK MOORE, THE CEO, AND HEATHER McCABE, WHO CEO, AND HEATHER McCABE, WHO IS AN ADJUNCT PROFESSOR AT THE IS AN ADJUNCT PROFESSOR AT THE McKINNEY SCHOOL OF LAW McKINNEY SCHOOL OF LAW THANKS ALL FOR BEING HERE THANKS ALL FOR BEING HERE TONIGHT TONIGHT NANCY, LET’S START WITH YOU, NANCY, LET’S START WITH YOU, WITH A GENERAL QUESTION, WHAT IS WITH A GENERAL QUESTION, WHAT IS YOUR SENSE OF, FIRST OF ALL, HOW YOUR SENSE OF, FIRST OF ALL, HOW MANY PEOPLE ARE UNINSURED IN THE MANY PEOPLE ARE UNINSURED IN THE STATE OF INDIANA AND ARE THERE STATE OF INDIANA AND ARE THERE SPECIFIC GROUPS OF PEOPLE YOU SPECIFIC GROUPS OF PEOPLE YOU ARE AWARE OF THAT HAVE LARGE ARE AWARE OF THAT HAVE LARGE SWATHS OF THAT GROUP OF PEOPLE SWATHS OF THAT GROUP OF PEOPLE WHO DO NOT HAVE ANY INSURANCE WHO DO NOT HAVE ANY INSURANCE THAT WILL THEN BE REQUIRED TO THAT WILL THEN BE REQUIRED TO BUY IT ONCE THE AFFORDABLE CARE BUY IT ONCE THE AFFORDABLE CARE ACT TAKES FULL EFFECT? ACT TAKES FULL EFFECT? >> WELL, ACTUALLY, THE NUMBERS >> WELL, ACTUALLY, THE NUMBERS ARE NOT ACCURATE, BECAUSE YOU ARE NOT ACCURATE, BECAUSE YOU HAVE SOME POPULATIONS THAT ARE HAVE SOME POPULATIONS THAT ARE JUST NOT BEING COUNTED BECAUSE JUST NOT BEING COUNTED BECAUSE THEY ARE NEW IMMIGRANTS INTO THE THEY ARE NEW IMMIGRANTS INTO THE STATE STATE SO THEY DON’T HAVE ACCESS TO SO THEY DON’T HAVE ACCESS TO HEALTH INSURANCE HEALTH INSURANCE BUT THERE’S HUNDREDS OF BUT THERE’S HUNDREDS OF THOUSANDS OF HOOSIERS THAT DO THOUSANDS OF HOOSIERS THAT DO NOT HAVE ACCESS TO HEALTH NOT HAVE ACCESS TO HEALTH INSURANCE, AS WELL AS DO NOT INSURANCE, AS WELL AS DO NOT HAVE ACCESS EVEN TO A COMMUNITY HAVE ACCESS EVEN TO A COMMUNITY HEALTH CLINIC IF THERE’S NOT ONE HEALTH CLINIC IF THERE’S NOT ONE IN THE COUNTY IN THE COUNTY >> DO YOU GET THE SENSE WE ARE >> DO YOU GET THE SENSE WE ARE TALKING ABOUT ONE IN 10, ONE IN TALKING ABOUT ONE IN 10, ONE IN 12, DO YOU HAVE ANY GUESS OF 12, DO YOU HAVE ANY GUESS OF WHAT PERCENT? WHAT PERCENT? >> I WOULD GUESS ABOUT 1 IN 12 >> I WOULD GUESS ABOUT 1 IN 12 >> HEATHER, LET ME GO TO YOU FOR >> HEATHER, LET ME GO TO YOU FOR A SECOND A SECOND I TALK WITH THE MAYORS OF GREEN I TALK WITH THE MAYORS OF GREEN CASTLE AND TERRE HAUTE, BOTH OF CASTLE AND TERRE HAUTE, BOTH OF WHO WERE INVOLVED IN HEALTHCARE WHO WERE INVOLVED IN HEALTHCARE BEFORE BECOMING MAYORS BEFORE BECOMING MAYORS ONE THING THEY TELL ME IS THERE ONE THING THEY TELL ME IS THERE ARE PEOPLE CURRENTLY FALLING ARE PEOPLE CURRENTLY FALLING THROUGH THE CRACKS, WHOLE GROUPS THROUGH THE CRACKS, WHOLE GROUPS OF PEOPLE THAT ARE NOT GETTING OF PEOPLE THAT ARE NOT GETTING THE COVERAGE AND THE ATTENTION THE COVERAGE AND THE ATTENTION THEY NEED WHAT IS YOUR SENSE THEY NEED WHAT IS YOUR SENSE ABOUT THOSE GROUPS OF PEOPLE? ABOUT THOSE GROUPS OF PEOPLE? WHO ARE THEY? WHO ARE THEY? WHO GETS HELPED DEPENDING ON WHO GETS HELPED DEPENDING ON WHAT INDIANA DECIDES OR DECIDES WHAT INDIANA DECIDES OR DECIDES NOT TO DO? NOT TO DO? >> WELL, WE CURRENTLY HAVE A >> WELL, WE CURRENTLY HAVE A SYSTEM WHERE IF YOU WANT TO GET SYSTEM WHERE IF YOU WANT TO GET HELP, THROUGH THE MEDICAID HELP, THROUGH THE MEDICAID PROGRAM, YOU HAVE TO BOTH PROGRAM, YOU HAVE TO BOTH QUALIFY FINANCIALLY AND QUALIFY FINANCIALLY AND CATEGORICALLY, WHICH MEANS YOU CATEGORICALLY, WHICH MEANS YOU HAVE TO BOTH HAVE FINANCIAL HAVE TO BOTH HAVE FINANCIAL INDICATORS AND YOU HAVE TO HAVE INDICATORS AND YOU HAVE TO HAVE A DISABILITY, OR SOME OTHER A DISABILITY, OR SOME OTHER PREGNANCY, A PREGNANT WOMAN, BE PREGNANCY, A PREGNANT WOMAN, BE A CHILD A CHILD THERE ARE CATEGORIES AND THERE ARE CATEGORIES AND FINANCIAL CRITERIA FINANCIAL CRITERIA IF, IN FACT, WE WOULD CHOOSE TO IF, IN FACT, WE WOULD CHOOSE TO GO TO AN EXPANDED MEDICAID GO TO AN EXPANDED MEDICAID PROGRAM, THOSE CATEGORIES WOULD PROGRAM, THOSE CATEGORIES WOULD GO A WAY AND WE WOULD ONLY FROM GO A WAY AND WE WOULD ONLY FROM THE FINANCIAL CRITERIA THE FINANCIAL CRITERIA INDIANA AS BRIDGED THE GAP INDIANA AS BRIDGED THE GAP SOMEWHAT THROUGH THE HEALTHY SOMEWHAT THROUGH THE HEALTHY INDIANA PLAN, BUT WE KNOW THAT INDIANA PLAN, BUT WE KNOW THAT THAT HAS LIMITED SLOTS THAT HAS LIMITED SLOTS IT HAS A FAIRLY SIGNIFICANT WAIT IT HAS A FAIRLY SIGNIFICANT WAIT LIST LIST THE SAME FOLKS WHO MIGHT BE THE SAME FOLKS WHO MIGHT BE SERVES UNDER THE HEALTHY INDIANA SERVES UNDER THE HEALTHY INDIANA PLAN MIGHT ALSO BE CAUGHT IF, IN PLAN MIGHT ALSO BE CAUGHT IF, IN FACT, INDIANA WOULD CHOOSE TO DO FACT, INDIANA WOULD CHOOSE TO DO SOME KIND OF MEDICAID EXPANSION SOME KIND OF MEDICAID EXPANSION >> IS IT STILL UP IN THE AIR? >> IS IT STILL UP IN THE AIR? DO THE THREE OF YOU GET THE DO THE THREE OF YOU GET THE SENSE THAT — LAWMAKERS ARE NOT SENSE THAT — LAWMAKERS ARE NOT SURE WHAT THEY WILL DO AS FAR AS SURE WHAT THEY WILL DO AS FAR AS EXPANDING MEDICAID ELIGIBILITY EXPANDING MEDICAID ELIGIBILITY OR NOT? OR NOT? >> OH, DEFINITELY >> OH, DEFINITELY THEY DON’T KNOW WHAT THEY WILL THEY DON’T KNOW WHAT THEY WILL DO TRYING TO IMPLEMENT THE DO TRYING TO IMPLEMENT THE AFFORDABLE CARE ACT AFFORDABLE CARE ACT BUT JUST TO TIE INTO HER ANSWER, BUT JUST TO TIE INTO HER ANSWER, ALSO YOU HAVE OVER 40 COUNTIES ALSO YOU HAVE OVER 40 COUNTIES HERE IN INDIANA THAT ARE HERE IN INDIANA THAT ARE MEDICALLY UNDER SERVED AREAS, MEDICALLY UNDER SERVED AREAS, HEALTHCARE PROFESSIONAL SHORTARM HEALTHCARE PROFESSIONAL SHORTARM AREAS SO THAT LIMITS — SHORTAGE AREAS SO THAT LIMITS — SHORTAGE AREAS SO THAT THAT LIMITS THEM, AREAS SO THAT THAT LIMITS THEM, AND THOSE FOLKS ARE FALLING AND THOSE FOLKS ARE FALLING THROUGH THE CRACKS THROUGH THE CRACKS >> MARK, YOU ARE SHAKING YOUR >> MARK, YOU ARE SHAKING YOUR HEAD HEAD HOW DO YOU DETERMINE WHETHER HOW DO YOU DETERMINE WHETHER SOMEONE IS UNDER SERVED AND SOMEONE IS UNDER SERVED AND WHETHER THEY MIGHT NEED TO BE WHETHER THEY MIGHT NEED TO BE PAID MORE ATTENTION TO? PAID MORE ATTENTION TO? >> WELL, FIRST THING I WOULD SAY >> WELL, FIRST THING I WOULD SAY IS THE HOSPITAL INDUSTRY HAS IS THE HOSPITAL INDUSTRY HAS BEEN VERY SUPPORTIVE IN GENERAL BEEN VERY SUPPORTIVE IN GENERAL OF THE AFFORDABLE CARE ACT OF THE AFFORDABLE CARE ACT BECAUSE OF THE EXPANSION OF BECAUSE OF THE EXPANSION OF ACCESS, THAT WE KNOW IF PEOPLE ACCESS, THAT WE KNOW IF PEOPLE HAVE HEALTH INSURANCE, THEY ARE HAVE HEALTH INSURANCE, THEY ARE MORE LIKELY TO GET THE PRIMARY MORE LIKELY TO GET THE PRIMARY CARE RELATIONSHIP THAT THEY NEED CARE RELATIONSHIP THAT THEY NEED WITH A PHYSICIAN OR A NURSE WITH A PHYSICIAN OR A NURSE PRACTITIONER, AND THAT LEADS YOU PRACTITIONER, AND THAT LEADS YOU INTO MORE PREVENTATIVE CARE THAN INTO MORE PREVENTATIVE CARE THAN JUST REACTIVE CARE AND ENDING UP JUST REACTIVE CARE AND ENDING UP IN OUR EMERGENCY DEPARTMENTS AS IN OUR EMERGENCY DEPARTMENTS AS A RESULT OF THAT LACK OF ACCESS A RESULT OF THAT LACK OF ACCESS SO IN GENERAL, THE INDUSTRY HAS SO IN GENERAL, THE INDUSTRY HAS BEEN VERY FAVORABLE, BUT THERE BEEN VERY FAVORABLE, BUT THERE WAS A TRADEOFF AND THAT TRADEOFF WAS A TRADEOFF AND THAT TRADEOFF WAS THE ACCEPTANCE OF FUTURE WAS THE ACCEPTANCE OF FUTURE MEDICARE AND SOME MEDICAID CUTS MEDICARE AND SOME MEDICAID CUTS IN EXCHANGE FOR AN EXPANSION OF IN EXCHANGE FOR AN EXPANSION OF THE ELIGIBILITY OF THE MEDICAID THE ELIGIBILITY OF THE MEDICAID SO PART OF THE CONCERN HERE IN SO PART OF THE CONCERN HERE IN INDIANA IS THE DOUBLE WHAMMY INDIANA IS THE DOUBLE WHAMMY THAT WE GET THE CUTS BUT WE THAT WE GET THE CUTS BUT WE DON’T GET THE EXPANSION AND THE DON’T GET THE EXPANSION AND THE ACCESS IMPROVEMENT FOR OUR ACCESS IMPROVEMENT FOR OUR POPULOUS POPULOUS SO PACK TO THE ORIGINAL SO PACK TO THE ORIGINAL QUESTION, I THINK THERE’S ALWAYS QUESTION, I THINK THERE’S ALWAYS A SCREENING PROCESS WE TRY TO A SCREENING PROCESS WE TRY TO USE TO SEE IF THERE’S USE TO SEE IF THERE’S ELIGIBILITY FOR SOME FORM OF ELIGIBILITY FOR SOME FORM OF INSURANCE, WHETHER IT BE INSURANCE, WHETHER IT BE MEDICAID, HEALTHY INDIANA PLAN, MEDICAID, HEALTHY INDIANA PLAN, JUST SOMETHING THAT GETS THAT JUST SOMETHING THAT GETS THAT RELATIONSHIP AND THEN — AND RELATIONSHIP AND THEN — AND PULLS DOWN THE BARRIER TO THE PULLS DOWN THE BARRIER TO THE ACCESS ISSUE I’M TALKING ABOUT ACCESS ISSUE I’M TALKING ABOUT >> SOME YEARS AGO, WELL BEFORE >> SOME YEARS AGO, WELL BEFORE WE EVEN STARTED TALKING ABOUT WE EVEN STARTED TALKING ABOUT THE AFFORDABLE CARE ACT, I HAD A THE AFFORDABLE CARE ACT, I HAD A FRIEND OF MINE WHO WAS AN E.M.T FRIEND OF MINE WHO WAS AN E.M.T SAY TO ME ONE OF THE PROBLEMS SAY TO ME ONE OF THE PROBLEMS WITH THE HEALTHCARE IN AMERICA, WITH THE HEALTHCARE IN AMERICA, WE ARE IN THE BUSINESS OF MAKING WE ARE IN THE BUSINESS OF MAKING PEOPLE BETTER, NOT MAKING THEM

PEOPLE BETTER, NOT MAKING THEM WELL WELL YOU KNOW, SO WE ARE ALWAYS YOU KNOW, SO WE ARE ALWAYS FIXING PROBLEMS RATHER THAN FIXING PROBLEMS RATHER THAN ANTICIPATING THEM ANTICIPATING THEM DO YOU SEE THAT THE CHANGES THAT DO YOU SEE THAT THE CHANGES THAT THE AFFORDABLE CARE ACT IS THE AFFORDABLE CARE ACT IS DESIGNED TO MAKE ARE GOING TO DESIGNED TO MAKE ARE GOING TO CHANGE THAT PROBLEM WITHIN THE CHANGE THAT PROBLEM WITHIN THE SYSTEM, THAT SORT OF STRUCTURAL SYSTEM, THAT SORT OF STRUCTURAL ISSUE? ISSUE? >> YES, IF YOU LET ME DIGRESS >> YES, IF YOU LET ME DIGRESS JUST FOR A QUICK SECOND, THERE JUST FOR A QUICK SECOND, THERE ARE TRENDS THAT HAVE BEEN ARE TRENDS THAT HAVE BEEN HAPPENING IN HEALTHCARE THAT ARE HAPPENING IN HEALTHCARE THAT ARE RELATED TO WHAT YOU ARE TALKING RELATED TO WHAT YOU ARE TALKING ABOUT, THAT WE GENERALLY SEE ABOUT, THAT WE GENERALLY SEE KIND OF A SLOW BUT SURE MOVEMENT KIND OF A SLOW BUT SURE MOVEMENT AWAY FROM BEING VOLUME ORIENTED, AWAY FROM BEING VOLUME ORIENTED, IN OTHER WORDS WE ARE REWARDED IN OTHER WORDS WE ARE REWARDED FOR HOW MANY THINGS WE DO, HOW FOR HOW MANY THINGS WE DO, HOW MANY ADMISSIONS AND HOW MANY MANY ADMISSIONS AND HOW MANY TESTS TO ALSO BEING ACCOUNTABLE TESTS TO ALSO BEING ACCOUNTABLE FOR THE OUTCOMES BOTH CLINICAL, FOR THE OUTCOMES BOTH CLINICAL, PATIENT SAT FACTION AND PATIENT SAT FACTION AND ULTIMATELY THE FINANCIAL ULTIMATELY THE FINANCIAL OUTCOMES OUTCOMES THESE TRENDS HAVE BEEN PUT IN THESE TRENDS HAVE BEEN PUT IN PLACE, AND STARTING TO MOVE, PLACE, AND STARTING TO MOVE, BOTH WITH FEDERAL REIMBURSEMENT BOTH WITH FEDERAL REIMBURSEMENT AND PRIVATE INSURERS AND PRIVATE INSURERS SO IN ONE SENSE, WHETHER IT WAS SO IN ONE SENSE, WHETHER IT WAS A REPUBLICAN OR A DEMOCRAT IN A REPUBLICAN OR A DEMOCRAT IN THE WHITE HOUSE, WE STILL SAW THE WHITE HOUSE, WE STILL SAW THESE TRENDS CONTINUING DOWN THE THESE TRENDS CONTINUING DOWN THE ROAD ROAD NOW THAT WE KNOW THE RESULTS OF NOW THAT WE KNOW THE RESULTS OF ELECTION, I THINK WE ARE MORE ELECTION, I THINK WE ARE MORE ASSURED THAT THE AFFORDABLE CARE ASSURED THAT THE AFFORDABLE CARE ACT WILL CONTINUE TO MOVE ACT WILL CONTINUE TO MOVE FORWARD IN SOME FORM OR FASHION FORWARD IN SOME FORM OR FASHION >> YOU WERE SHAKING YOUR HEAD A >> YOU WERE SHAKING YOUR HEAD A SECOND AGO, NANCY SECOND AGO, NANCY >> YEAH, BECAUSE ALSO IN >> YEAH, BECAUSE ALSO IN AFFORDABLE CARE ACT, IT AFFORDABLE CARE ACT, IT DISCUSSED PREVENTATIVE HEALTH DISCUSSED PREVENTATIVE HEALTH SERVICES, WHICH A LOT OF TIMES SERVICES, WHICH A LOT OF TIMES OUR SYSTEM IS NOT SUPPORTIVE OF, OUR SYSTEM IS NOT SUPPORTIVE OF, AS FAR AS FEDERAL DOLLARS AS FAR AS FEDERAL DOLLARS IT USUALLY GOES TOWARDS IT USUALLY GOES TOWARDS TREATMENT TREATMENT WOMEN’S HEALTH, PREVENTATIVE WOMEN’S HEALTH, PREVENTATIVE HEALTH SERVICES HAS REALLY HEALTH SERVICES HAS REALLY EXPANDED WITHIN THE AFFORDABLE EXPANDED WITHIN THE AFFORDABLE CARE ACT, IF ALL OF THAT IS — CARE ACT, IF ALL OF THAT IS — SOME OF THAT IS — IF ALL OF SOME OF THAT IS — IF ALL OF THAT IS MANDATORY AND INDIANA THAT IS MANDATORY AND INDIANA SELECTS TO INCORPORATE THAT IN SELECTS TO INCORPORATE THAT IN THEIR ESSENTIAL HEALTH BENEFIT THEIR ESSENTIAL HEALTH BENEFIT >> I’M INTERESTED TO GET A >> I’M INTERESTED TO GET A THOUGHT FROM ALL THREE OF YOU THOUGHT FROM ALL THREE OF YOU AND HEATHER, I WILL SPEAK TO AND HEATHER, I WILL SPEAK TO YOU YOU WHEN HOUSE SPEAKER, BRIAN WHEN HOUSE SPEAKER, BRIAN BOSSMAN NAMEBOSSMAN NAMED HIS PS BOSSMAN NAMEBOSSMAN NAMED HIS PS A PHYSICIAN A PHYSICIAN I WOULD LIKE TO KNOW YOUR I WOULD LIKE TO KNOW YOUR THOUGHTS ABOUT THE PHYSICIAN IS THOUGHTS ABOUT THE PHYSICIAN IS GOING TO BE LEADING THE MONEY GOING TO BE LEADING THE MONEY SIDE OF THE HOUSE OF SIDE OF THE HOUSE OF REPRESENTATIVES IN INDIANA FOR REPRESENTATIVES IN INDIANA FOR AT LEAST THIS BUDGET CYCLE THAT AT LEAST THIS BUDGET CYCLE THAT WILL BEGIN IN JANUARY AND HOW WILL BEGIN IN JANUARY AND HOW THAT — HOW THE STATE IS GOING THAT — HOW THE STATE IS GOING TO LOOK AT THE AFFORDABLE CARE TO LOOK AT THE AFFORDABLE CARE ACT ACT >> FROM MY PERSPECTIVE, I THINK >> FROM MY PERSPECTIVE, I THINK THAT IT WILL BRING SOME THAT IT WILL BRING SOME EXPERIENCE IN THE AREA TO THAT EXPERIENCE IN THE AREA TO THAT PARTICULAR POSITION PARTICULAR POSITION AND SOMEONE WHO HAS SOME AND SOMEONE WHO HAS SOME KNOWLEDGE ABOUT HEALTHCARE, AND KNOWLEDGE ABOUT HEALTHCARE, AND HEALTHCARE FINANCING HEALTHCARE FINANCING I WILL SAY THAT NOT HAVING HAD I WILL SAY THAT NOT HAVING HAD INTERACTION WITH HIM, AND INTERACTION WITH HIM, AND KNOWING HIM SPECIFICALLY, I’M KNOWING HIM SPECIFICALLY, I’M NOT SURE EXACTLY HOW THAT WILL NOT SURE EXACTLY HOW THAT WILL PLAY OUT, BUT I DO BELIEVE THAT PLAY OUT, BUT I DO BELIEVE THAT IT WILL BE IMPORTANT TO HAVE IT WILL BE IMPORTANT TO HAVE SOMEONE WHO HAS SOME KNOWLEDGE SOMEONE WHO HAS SOME KNOWLEDGE OF HEALTHCARE FUNDING OF HEALTHCARE FUNDING I THINK THE HEALTHCARE AND THE I THINK THE HEALTHCARE AND THE HEALTHCARE ACCESS AND ALL OF THE HEALTHCARE ACCESS AND ALL OF THE COMPONENTS OF THE AFFORDABLE COMPONENTS OF THE AFFORDABLE CARE ACT ARE GOING TO BE A LARGE CARE ACT ARE GOING TO BE A LARGE PORTION OF THE — OF THE NEXT PORTION OF THE — OF THE NEXT BUDGET, AND AS WE MOVE FORWARD, BUDGET, AND AS WE MOVE FORWARD, WHAT WE ARE GOING TO DO WHAT WE ARE GOING TO DO LEGISLATIVELY LEGISLATIVELY >> MARK, YOUR THOUGHTS >> MARK, YOUR THOUGHTS >> I WOULD GENERALLY SUPPORT THE >> I WOULD GENERALLY SUPPORT THE THOUGHT THAT IF YOU HAVE SOMEONE THOUGHT THAT IF YOU HAVE SOMEONE FAMILIAR WITH HEALTH CARE, FAMILIAR WITH HEALTH CARE, INTIMATELY TRAINED IN THAT INTIMATELY TRAINED IN THAT PROFESSION, THEY SHOULD PROFESSION, THEY SHOULD CERTAINLY APPRECIATE PROVIDE CERTAINLY APPRECIATE PROVIDE MARE CARE, THE ACCESS THE MARE CARE, THE ACCESS THE PATIENTS NEED AND MORE ABOUT PATIENTS NEED AND MORE ABOUT PREVENTATIVE CARE FOR THE PREVENTATIVE CARE FOR THE LONG-TERM BENEFIT OF OUR LONG-TERM BENEFIT OF OUR SOCIETY SOCIETY >> WE HAVE DELL WITH HIM FOR >> WE HAVE DELL WITH HIM FOR YEARS AN I KNOW — WE HAVE DEALT YEARS AN I KNOW — WE HAVE DEALT WITH HIM FOR YORES AND I KNOW WITH HIM FOR YORES AND I KNOW HAS SET ON ON THE HEALTH HAS SET ON ON THE HEALTH COMMITTEE AND HE ALWAYS DEALT COMMITTEE AND HE ALWAYS DEALT WITH HEALTH INITIATIVES WITH HEALTH INITIATIVES MAYBE THAT’S BECAUSE HE’S A MAYBE THAT’S BECAUSE HE’S A DOCTOR AND HE SEES THE BENEFIT DOCTOR AND HE SEES THE BENEFIT OF IT OR MAYBE IT’S BECAUSE HE OF IT OR MAYBE IT’S BECAUSE HE UNDERSTANDS THAT YOU HAVE TO DO UNDERSTANDS THAT YOU HAVE TO DO PREVENTATIVE HEALTH AND OTHER PREVENTATIVE HEALTH AND OTHER THINGS SO YOU DON’T HAVE TO PAY THINGS SO YOU DON’T HAVE TO PAY MORE DOWN THE ROAD MORE DOWN THE ROAD >> LET’S START WITH YOU, NANCY, >> LET’S START WITH YOU, NANCY, ON THE NEXT QUESTION ON THE NEXT QUESTION ONE OF THE KORES CORE ISSUES IS ONE OF THE KORES CORE ISSUES IS GOVERNOR-ELECT PENCE SAYS HE GOVERNOR-ELECT PENCE SAYS HE WILL LET THE FEDERAL GOVERNMENT WILL LET THE FEDERAL GOVERNMENT RUN THE AFFORDABLE CARE ACT IN RUN THE AFFORDABLE CARE ACT IN INDIANA INDIANA HE DOESN’T WANT TO SET UP A HE DOESN’T WANT TO SET UP A STATE EXCHANGE STATE EXCHANGE I WOULD LIKE EACH OF YOUR I WOULD LIKE EACH OF YOUR THOUGHTS ON BETTER TO HAVE A THOUGHTS ON BETTER TO HAVE A STATE EXCHANGE OR BETTER TO LET STATE EXCHANGE OR BETTER TO LET 9 FEDERAL GOVERNMENT, WHICH HAS 9 FEDERAL GOVERNMENT, WHICH HAS BEEN PLANNING FOR THIS FOR YEARS BEEN PLANNING FOR THIS FOR YEARS AND YEARS, WHEREAS THE INDIANA AND YEARS, WHEREAS THE INDIANA HAS BEEN RELUCTANT TO PLAN AT HAS BEEN RELUCTANT TO PLAN AT ALL, BASED ON POLITICS ALL, BASED ON POLITICS BETTER TO HAVE A STATE EXCHANGE BETTER TO HAVE A STATE EXCHANGE OR THE FEDERAL EXCHANGE RUNNING OR THE FEDERAL EXCHANGE RUNNING THINGS IN INDIANA? THINGS IN INDIANA? >> WELL, IT DEPENDS ON WHAT YOU >> WELL, IT DEPENDS ON WHAT YOU HAVE AS BENEFITS IN THE HAVE AS BENEFITS IN THE EXCHANGE EXCHANGE IN SOME STATES, IT WOULD BE IN SOME STATES, IT WOULD BE BETTER TO HAVE THE STATE RUN IT BETTER TO HAVE THE STATE RUN IT BUT I’M NOT SURE IN THIS BUT I’M NOT SURE IN THIS SITUATION HOW THAT WOULD IMPACT SITUATION HOW THAT WOULD IMPACT ON PEOPLE BEING ABLE TO ACCESS ON PEOPLE BEING ABLE TO ACCESS AND GETTING THE SUPPORT THEY AND GETTING THE SUPPORT THEY NEED NEED >> OKAY >> OKAY MARK, YOUR THOUGHTS? MARK, YOUR THOUGHTS? >> I’M GENERALLY ALWAYS IN FAVOR >> I’M GENERALLY ALWAYS IN FAVOR OF STATES’ RIGHTS SO TO SPEAK IN OF STATES’ RIGHTS SO TO SPEAK IN THE SENSE THAT I THINK OUR THE SENSE THAT I THINK OUR UNDERSTANDING OF OUR UNDERSTANDING OF OUR MARKETPLACE, OUR ISSUES MARKETPLACE, OUR ISSUES INVOLVING PROVIDERS AN KEY INVOLVING PROVIDERS AN KEY LEGISLATORS WOULD BE MORE LEGISLATORS WOULD BE MORE SUCCESSFUL IN MEETING OUR NEEDS SUCCESSFUL IN MEETING OUR NEEDS >> HEATHER? >> HEATHER? >> I THINK I WOULD SAY THAT THE >> I THINK I WOULD SAY THAT THE HOSPITAL INDUSTRY AND THE HOSPITAL INDUSTRY AND THE INSURANCE INDUSTRY HAS ALSO INSURANCE INDUSTRY HAS ALSO TENDED TO SUPPORT THE STATES TENDED TO SUPPORT THE STATES RUNNING EXCHANGES BECAUSE OF THE RUNNING EXCHANGES BECAUSE OF THE VERY THINGS THAT MARK POINTED VERY THINGS THAT MARK POINTED OUT OUT THE STATES CAN BE MORE THE STATES CAN BE MORE RESPONSIVE TO THE SPECIFIC RESPONSIVE TO THE SPECIFIC NEEDS NEEDS THERE MAY BE SOME WHO SAY A

THERE MAY BE SOME WHO SAY A FEDERAL EXCHANGE, A FEDERALLY FEDERAL EXCHANGE, A FEDERALLY BASED PROGRAM WOULD BE BETTER BASED PROGRAM WOULD BE BETTER BECAUSE IT PROVIDES MORE BECAUSE IT PROVIDES MORE CONTINUITY AND A MORE CONTINUITY AND A MORE CENTRALIZED FOCUS, BUT, AGAIN, I CENTRALIZED FOCUS, BUT, AGAIN, I THINK INDUSTRY HAS CERTAINLY THINK INDUSTRY HAS CERTAINLY BEEN VERY SUPPORTIVE OF STATE BEEN VERY SUPPORTIVE OF STATE EXCHANGES AND FOR THOSE WOULD EXCHANGES AND FOR THOSE WOULD TEND TO SEE MORE STATES’ RIGHTS, TEND TO SEE MORE STATES’ RIGHTS, I WOULD THINK A STATE — A I WOULD THINK A STATE — A STATE-BASED EXCHANGE WOULD ALSO STATE-BASED EXCHANGE WOULD ALSO BE SOMETHING WISE BE SOMETHING WISE ONE OF THE THINGS TO NOTE, EVEN ONE OF THE THINGS TO NOTE, EVEN IF INDIANA DOESN’T DO A IF INDIANA DOESN’T DO A STATE-RUN EXCHANGE AT THIS STATE-RUN EXCHANGE AT THIS MOMENT, IT’S NOT PRECLUDED THAT MOMENT, IT’S NOT PRECLUDED THAT WE MIGHT DO A HYBRID WE MIGHT DO A HYBRID THIS WAS SOME CONCERN ABOUT A THIS WAS SOME CONCERN ABOUT A HYBRID EXCHANGE IN THE DEBATES HYBRID EXCHANGE IN THE DEBATES BUT AS I UNDERSTAND LATELY, THAT BUT AS I UNDERSTAND LATELY, THAT DOOR HAS NOT BEEN COMPLETELY DOOR HAS NOT BEEN COMPLETELY SHUT TO DO A HYBRID EXCHANGE SHUT TO DO A HYBRID EXCHANGE ALSO IF WE CHOOSE NOT TO DO A ALSO IF WE CHOOSE NOT TO DO A STATE-BASED EXCHANGE THIS YEAR, STATE-BASED EXCHANGE THIS YEAR, THAT DOES NOT PRECLUDE US FROM THAT DOES NOT PRECLUDE US FROM NEXT YEAR FROM APPLYING TO DO A NEXT YEAR FROM APPLYING TO DO A STATE-BASED EXCHANGE IF WE FIND STATE-BASED EXCHANGE IF WE FIND IT WOULD BE BETTER UNITED TO IT WOULD BE BETTER UNITED TO INDIANA NEEDS INDIANA NEEDS >> WHAT ARE SOME INDIANA >> WHAT ARE SOME INDIANA SPECIFIC ISSUES THAT YOU THINK SPECIFIC ISSUES THAT YOU THINK NEED TO BE PAID MORE ATTENTION NEED TO BE PAID MORE ATTENTION TO THAN THEY MIGHT BE IN TO THAN THEY MIGHT BE IN ILLINOIS OR KENTUCKY OR OHIO? ILLINOIS OR KENTUCKY OR OHIO? ARE THERE SPECIFIC CONDITIONS, ARE THERE SPECIFIC CONDITIONS, SPECIFIC GROUPS OF PEOPLE, SPECIFIC GROUPS OF PEOPLE, FACTORS ABOUT A LOT OF RURAL FACTORS ABOUT A LOT OF RURAL GEOGRAPHY IN INDIANA THAT YOU GEOGRAPHY IN INDIANA THAT YOU THINK THE STATE WOULD BE MORE THINK THE STATE WOULD BE MORE INCLINED TO PAY SPECIAL INCLINED TO PAY SPECIAL ATTENTION TO THAT THE FEDERAL ATTENTION TO THAT THE FEDERAL GOVERNMENT MIGHT OVERLOOK? GOVERNMENT MIGHT OVERLOOK? >> IF YOU LOOK AT OUR PUBLIC >> IF YOU LOOK AT OUR PUBLIC HEALTH NUMBERS, IF YOU LOOK AT HEALTH NUMBERS, IF YOU LOOK AT THE WAY THAT WE DO PREVENTATIVE THE WAY THAT WE DO PREVENTATIVE HEALTH, OUR OBESITY RATES, OUR HEALTH, OUR OBESITY RATES, OUR SMOKING RATES, MOST OF THOSE SMOKING RATES, MOST OF THOSE PUBLIC HEALTH INDICATORS, PUBLIC HEALTH INDICATORS, INDIANA DOES NOT FARE TERRIBLY INDIANA DOES NOT FARE TERRIBLY WELL COMPARATIVELY TO OTHER WELL COMPARATIVELY TO OTHER STATES STATES SO AS BOTH OF YOU HAVE MENTIONED SO AS BOTH OF YOU HAVE MENTIONED THAT PREVENTION PIECE, AS THAT PREVENTION PIECE, AS SOMETHING THAT IF INDIANA REALLY SOMETHING THAT IF INDIANA REALLY WANTS TO BE FISCALLY WANTS TO BE FISCALLY RESPONSIBLE, AS IT MOVES FORWARD RESPONSIBLE, AS IT MOVES FORWARD IN HEALTHCARE, THEY WILL HAVE TO IN HEALTHCARE, THEY WILL HAVE TO PAY ATTENTION TO THE PREVENTION PAY ATTENTION TO THE PREVENTION COMPONENTS COMPONENTS AND WE ALSO ARE GOING TO HAVE TO AND WE ALSO ARE GOING TO HAVE TO ENSURE THAT WE DO HAVE THE ENSURE THAT WE DO HAVE THE WORKFORCE AVAILABLE TO HAVE WORKFORCE AVAILABLE TO HAVE THIS — YOU KNOW, YOU, I THINK, THIS — YOU KNOW, YOU, I THINK, MENTIONED A COUPLE OF TIMES THE MENTIONED A COUPLE OF TIMES THE PRIMARY CARE RELATIONSHIP PRIMARY CARE RELATIONSHIP DO WE HAVE A WORKFORCED TRAINED DO WE HAVE A WORKFORCED TRAINED TO PROVIDE THE PRIMARY CARE TO PROVIDE THE PRIMARY CARE THAT’S NEEDED? THAT’S NEEDED? AND IF NOT, HOW WILL WE MOVE AND IF NOT, HOW WILL WE MOVE FORWARD IN THAT? FORWARD IN THAT? AND INDIANA CAN REALLY LOOK AT AND INDIANA CAN REALLY LOOK AT THAT THAT >> SEE, I’M VERY SUPPORTIVE OF >> SEE, I’M VERY SUPPORTIVE OF US, AGAIN, MOVING LIKE I SAID US, AGAIN, MOVING LIKE I SAID FROM A VALUE-BASED INDUSTRY — FROM A VALUE-BASED INDUSTRY — FROM A VOLUME-BASED INDUSTRY TO FROM A VOLUME-BASED INDUSTRY TO A VALUE-BASED INDUSTRY THAT A VALUE-BASED INDUSTRY THAT MACES US MORE AT RISK AS MACES US MORE AT RISK AS PROVIDERS FOR POPULATION HEALTH, PROVIDERS FOR POPULATION HEALTH, FOR REALLY TRYING TO TAKE CARE FOR REALLY TRYING TO TAKE CARE OF PATIENTS IN TERMS OF THEIR OF PATIENTS IN TERMS OF THEIR TOTALITY, BECAUSE IT REALIGNS TOTALITY, BECAUSE IT REALIGNS THE INCENTIVES THE INCENTIVES THE INCENTIVES ARE TODAY TO TAKE THE INCENTIVES ARE TODAY TO TAKE CARE OF DISEASE CARE OF DISEASE GIVE US THE INCENTIVES TO TAKE GIVE US THE INCENTIVES TO TAKE CARE OF HEALTH CARE OF HEALTH >> RIGHT >> RIGHT >> MARK, LET ME ASK YOU, FROM >> MARK, LET ME ASK YOU, FROM THE POINT OF VIEW OF AN THE POINT OF VIEW OF AN INDIVIDUAL HOSPITAL OR AN INDIVIDUAL HOSPITAL OR AN INDIVIDUAL HEALTHCARE PROVIDER, INDIVIDUAL HEALTHCARE PROVIDER, WHAT DIFFERENCES DO THINK THEY WHAT DIFFERENCES DO THINK THEY WILL SEE BY, SAY, THE MIDDLE OF WILL SEE BY, SAY, THE MIDDLE OF 2014, WHEN THIS IS FULLY 2014, WHEN THIS IS FULLY IMPLEMENTED? IMPLEMENTED? HOW IS THEIR BUSINESS, HOW IS HOW IS THEIR BUSINESS, HOW IS THEIR DAY-TO-DAY WORK GOING TO THEIR DAY-TO-DAY WORK GOING TO CHANGE IF AT ALL? CHANGE IF AT ALL? >> WELL, BY 2014, I’M NOT SURE >> WELL, BY 2014, I’M NOT SURE THERE WILL BE DRAMATIC CHANGE THERE WILL BE DRAMATIC CHANGE OTHER THAN THE BEGINNING OF OTHER THAN THE BEGINNING OF INCREASING OUR RISK INCREASING OUR RISK FOR INSTANCE, IN MEDICARE FOR INSTANCE, IN MEDICARE REIMBURSEMENT, WE WILL BE CLOSED REIMBURSEMENT, WE WILL BE CLOSED TO 10% AT RISK FOR THE CLINICAL TO 10% AT RISK FOR THE CLINICAL OUTCOMES AND PATIENT OUTCOMES AND PATIENT SATISFACTION SATISFACTION >> WHAT DO YOU MEAN AT RISK? >> WHAT DO YOU MEAN AT RISK? >> THEY HAVE CERTAIN >> THEY HAVE CERTAIN BENCHMARKS — THE FEDERAL BENCHMARKS — THE FEDERAL GOVERNMENT WILL SET CERTAIN GOVERNMENT WILL SET CERTAIN BENCHMARKS FOR THE ATTAINMENT OF BENCHMARKS FOR THE ATTAINMENT OF CERTAIN CLINICAL OUTCOMES AND CERTAIN CLINICAL OUTCOMES AND THEN ALSO FOR PERCENTAGE OF THEN ALSO FOR PERCENTAGE OF PATIENTS WHO RESPOND FAVORABLY PATIENTS WHO RESPOND FAVORABLY THAT YOU — YOU HAD EXCELLENT THAT YOU — YOU HAD EXCELLENT CARE IN YOUR INSTITUTION, CARE IN YOUR INSTITUTION, ET CETERA, AND IF YOU FALL BELOW ET CETERA, AND IF YOU FALL BELOW THOSE BENCHMARKS, THERE’S A THOSE BENCHMARKS, THERE’S A CERTAIN ELEMENT OF YOUR CERTAIN ELEMENT OF YOUR REIMBURSEMENT, IN THIS CASE, UP REIMBURSEMENT, IN THIS CASE, UP TO 10% THAT WOULD BE AT RISK FOR TO 10% THAT WOULD BE AT RISK FOR LOSING THAT PAYMENT LOSING THAT PAYMENT >> WE TALKED TO A COUPLE OF >> WE TALKED TO A COUPLE OF HOSPITALS HOSPITALS I TALKED TO SOMEONE AT UNION I TALKED TO SOMEONE AT UNION HOSPITAL A FEW WEEKS AGO, WHO HOSPITAL A FEW WEEKS AGO, WHO SAID THEY WERE GOING TO LOSE SAID THEY WERE GOING TO LOSE POTENTIALLY HUNDREDS OF POTENTIALLY HUNDREDS OF THOUSANDS OF DOLLARS BECAUSE THOUSANDS OF DOLLARS BECAUSE THEY HAD TOO MANY READMITS BASED THEY HAD TOO MANY READMITS BASED ON, YOU KNOW, POOR HEALTH ON, YOU KNOW, POOR HEALTH OUTCOMES WITHIN 30 DAYS OF BEING OUTCOMES WITHIN 30 DAYS OF BEING RELEASED FROM THE HOSPITAL AND RELEASED FROM THE HOSPITAL AND SO THAT’S CERTAINLY SOMETHING SO THAT’S CERTAINLY SOMETHING THAT I THINK A LOT OF HOSPITALS THAT I THINK A LOT OF HOSPITALS ARE CONCERNED ABOUT, IS LOSING ARE CONCERNED ABOUT, IS LOSING MONEY IN THIS FASHION MONEY IN THIS FASHION >> AND THAT’S AN EXAMPLE OF AN >> AND THAT’S AN EXAMPLE OF AN OUTCOME THAT I’M TALKING ABOUT, OUTCOME THAT I’M TALKING ABOUT, READMISSION RATE READMISSION RATE >> NANCY, LET ME ASK YOU FIRST >> NANCY, LET ME ASK YOU FIRST ON THIS, AND WE WILL GO BACK ON THIS, AND WE WILL GO BACK DOWN THE PANEL REAL QUICK DOWN THE PANEL REAL QUICK EVEN IF THE STATE GOES THE EVEN IF THE STATE GOES THE FEDERAL ROUTE, AND IT LETS THE FEDERAL ROUTE, AND IT LETS THE FEDERAL GOVERNMENT DO THIS, AND FEDERAL GOVERNMENT DO THIS, AND BY ALL ACCOUNTS THAT WILL COST BY ALL ACCOUNTS THAT WILL COST LESS, MAYBE AS MUCH AS LESS, MAYBE AS MUCH AS $1 BILLION LESS THAN $1 BILLION LESS THAN IMPLEMENTING IT STATEWIDE, THEY IMPLEMENTING IT STATEWIDE, THEY HAVE SAID HAVE SAID DOES THE STATE NEED TO ALLOCATE DOES THE STATE NEED TO ALLOCATE NONETHELESS, MORE MONEY TO ITS NONETHELESS, MORE MONEY TO ITS HEALTHCARE COVERAGE TO COVERING HEALTHCARE COVERAGE TO COVERING HOOSIERS AND MAKING SURE THAT HOOSIERS AND MAKING SURE THAT THEY ARE SEEING BETTER HEALTH THEY ARE SEEING BETTER HEALTH OUTCOMES MAYBE EVEN IF THAT OUTCOMES MAYBE EVEN IF THAT MEANS DIPPING INTO WHAT IS AT MEANS DIPPING INTO WHAT IS AT THE MOMENT A $2 BILLION BUDGET THE MOMENT A $2 BILLION BUDGET SURPLUS? SURPLUS? >> DOES THE STATE OF INDIANA >> DOES THE STATE OF INDIANA NEED TO DEVOTE MORE MONEY TO NEED TO DEVOTE MORE MONEY TO HEALTHCARE BROADLY? HEALTHCARE BROADLY? >> OH, YEAH >> OH, YEAH I THINK THEY NEED TO PROVIDE I THINK THEY NEED TO PROVIDE MORE DOLLARS FOR PREVENTATIVE MORE DOLLARS FOR PREVENTATIVE HEALTH SERVICES HEALTH SERVICES RIGHT NOW, THEY ARE LOOKING AT RIGHT NOW, THEY ARE LOOKING AT DISMANTLING THE AT-RISK DISMANTLING THE AT-RISK INSURANCE POOL AT THE END OF INSURANCE POOL AT THE END OF THIS YEAR WHICH MEANS IT MIGHT

THIS YEAR WHICH MEANS IT MIGHT NOT GO AWAY NOT GO AWAY THOSE PEOPLE HAVE TO BE PLACED THOSE PEOPLE HAVE TO BE PLACED SOME PLACE AND IT MIGHT BE THE SOME PLACE AND IT MIGHT BE THE STAY THAT HAS TO FUND THAT STAY THAT HAS TO FUND THAT >> CAN YOU EXPLAIN THAT FOR JUST >> CAN YOU EXPLAIN THAT FOR JUST A SECOND? A SECOND? >> AT-RISK INSURANCE POOL WAS >> AT-RISK INSURANCE POOL WAS AROUND BEFORE HIP, BUT IT MIGHT AROUND BEFORE HIP, BUT IT MIGHT HAVE BEEN FOR PEOPLE WHO WERE HAVE BEEN FOR PEOPLE WHO WERE DENIED THROUGH ANTHEM FOR DENIED THROUGH ANTHEM FOR INSURANCE COVERAGE AND SO THEY INSURANCE COVERAGE AND SO THEY BUY INTO INSURANCE BUY INTO INSURANCE IT’S A LITTLE COSTLY BUT IT’S IT’S A LITTLE COSTLY BUT IT’S CHEAPER THAN BUYING INTO IT IF CHEAPER THAN BUYING INTO IT IF YOU WERE GOING WITH ANTHEM OR YOU WERE GOING WITH ANTHEM OR ONE ONE OTHER INSURANCE PROVIDERS OTHER INSURANCE PROVIDERS SO THEY ARE HOOKING AT SO THEY ARE HOOKING AT DISMANTLE — SO THEY ARE HOOKING DISMANTLE — SO THEY ARE HOOKING AT DISMANTLING THAT GOING INTO AT DISMANTLING THAT GOING INTO NEXT YEAR NEXT YEAR THEY WILL HAVE TO PUT THEM THEY WILL HAVE TO PUT THEM SOMEPLACE AND WHERE THEY PUT SOMEPLACE AND WHERE THEY PUT THEM, I DON’T KNOW THEM, I DON’T KNOW I WILL HAVE TO USE STATE DOLLARS I WILL HAVE TO USE STATE DOLLARS TO SUPPLEMENT SOMETHING ELSE TO TO SUPPLEMENT SOMETHING ELSE TO ISSUE THOSE FOLKS ISSUE THOSE FOLKS >> MORE MONEY SPENT ON >> MORE MONEY SPENT ON HEALTHCARE IN INDIANA FROM THE HEALTHCARE IN INDIANA FROM THE STATE LEVEL? STATE LEVEL? >> I THINK IF IT’S DONE >> I THINK IF IT’S DONE CORRECTLY, IT SAYS DR. STONE ON CORRECTLY, IT SAYS DR. STONE ON THE EARLIER CLIP, SAID IT’S AN THE EARLIER CLIP, SAID IT’S AN INVESTMENT IN THE QUALITY OF INVESTMENT IN THE QUALITY OF LIFE AND ULTIMATELY THE ECONOMIC LIFE AND ULTIMATELY THE ECONOMIC WELL BEING OF THE STATE THAT I’M WELL BEING OF THE STATE THAT I’M BACK TO PRIMARY CARE AGAIN, THAT BACK TO PRIMARY CARE AGAIN, THAT IF PATIENTS AND FAMILIES HAVE IF PATIENTS AND FAMILIES HAVE SOME FORM OF RELATIONSHIP, THEY SOME FORM OF RELATIONSHIP, THEY CAN BE THEIR MEDICAL HOME, HELP CAN BE THEIR MEDICAL HOME, HELP THEM GUIDE THEM THROUGH THE THEM GUIDE THEM THROUGH THE MEDICAL DELIVERY SYSTEM, AND MEDICAL DELIVERY SYSTEM, AND START TO PLAY SOME INCENTIVES ON START TO PLAY SOME INCENTIVES ON THEIR HEALTH AND WELL BEING, THEIR HEALTH AND WELL BEING, THAT THAT ULTIMATELY, BEHOOVES THAT THAT ULTIMATELY, BEHOOVES THE STAY OF INDIANA TO MAKE MORE THE STAY OF INDIANA TO MAKE MORE INVESTMENT INVESTMENT >> HEATHER, YOUR THOUGHTS? >> HEATHER, YOUR THOUGHTS? >> I’M GOING TO AGREE WITH MY >> I’M GOING TO AGREE WITH MY COLLEAGUES HERE COLLEAGUES HERE I THINK THIS INVESTMENT, AGAIN, I THINK THIS INVESTMENT, AGAIN, WHEN WE LOOK AT THE PUBLIC WHEN WE LOOK AT THE PUBLIC HEALTH NUMBERS FOR INDIANA, OUR HEALTH NUMBERS FOR INDIANA, OUR OBESITY RATE, OUR SMOKING RATE, OBESITY RATE, OUR SMOKING RATE, WE’RE NOT DOING WELL, AND IT WE’RE NOT DOING WELL, AND IT COSTS US A LOT IN THE END TO COSTS US A LOT IN THE END TO TAKE CARE 6 OF THE PROBLEMS THAT TAKE CARE 6 OF THE PROBLEMS THAT COME DOWN THE PATH BECAUSE WE COME DOWN THE PATH BECAUSE WE HAVE NOT PUT THE MONEY INTO HAVE NOT PUT THE MONEY INTO PREVENTION PREVENTION IT IS A LOT OF MONEY, WHEN WE IT IS A LOT OF MONEY, WHEN WE TALK ABOUT THE RAW DOLLARS AND TALK ABOUT THE RAW DOLLARS AND WE ARE TALKING ABOUT MILLIONS WE ARE TALKING ABOUT MILLIONS AND BILLIONS OF DOLLARS, IT IS A AND BILLIONS OF DOLLARS, IT IS A SCARY PROPOSITION SCARY PROPOSITION BUT I THINK THAT THE — THE BUT I THINK THAT THE — THE CONCERN IS, WHAT IF WE DON’T CONCERN IS, WHAT IF WE DON’T INVEST THOSE DOLLARS, INVEST THOSE DOLLARS, PARTICULARLY WHEN WE HAVE PARTICULARLY WHEN WE HAVE HOSPITALS, OUR DISPROPORTIONATE HOSPITALS, OUR DISPROPORTIONATE SHARE OF HOSPITALS? SHARE OF HOSPITALS? WE ALREADY ASKED THEM TO MAKE WE ALREADY ASKED THEM TO MAKE SOME CHANGES BECAUSE WE INTEND, SOME CHANGES BECAUSE WE INTEND, THROUGH THE AFFORDABLE CARE ACT THROUGH THE AFFORDABLE CARE ACT COVER MORE PEOPLE THROUGH THESE COVER MORE PEOPLE THROUGH THESE MEDICAID EXPANSIONS MEDICAID EXPANSIONS IF WE DON’T INVEST IN THAT, I DO IF WE DON’T INVEST IN THAT, I DO HAVE SOME CONCERNS FOR WHAT THAT HAVE SOME CONCERNS FOR WHAT THAT WILL MEAN FOR OUR HOSPITALS, WHO WILL MEAN FOR OUR HOSPITALS, WHO BOTH HAVE MADE THESE CONCESSIONS BOTH HAVE MADE THESE CONCESSIONS FOR THAT, AND STILL NOW HAVE TO FOR THAT, AND STILL NOW HAVE TO COVER CARE FOR PEOPLE WHO DON’T COVER CARE FOR PEOPLE WHO DON’T HAVE COVERAGE THROUGH OTHER HAVE COVERAGE THROUGH OTHER MEANS MEANS AND THE PREEXISTING CONDITION AND THE PREEXISTING CONDITION COMPONENT THAT YOU ARE SPEAKING COMPONENT THAT YOU ARE SPEAKING OF, EARLIER IN TERMS OF THE OF, EARLIER IN TERMS OF THE PEOPLE WHO WERE COVERED BY THE PEOPLE WHO WERE COVERED BY THE COMPREHENSIVE HEALTH INSURANCE, COMPREHENSIVE HEALTH INSURANCE, PEOPLE WHO COULD NOT GET HEALTH PEOPLE WHO COULD NOT GET HEALTH COVER IMELSEWHERECOVERAGE ELSEW COVER IMELSEWHERECOVERAGE ELSEW THEY WILL NOT BE ABLE TO BE THEY WILL NOT BE ABLE TO BE DENIED FOR PREEXISTING DENIED FOR PREEXISTING CONDITIONS CONDITIONS SO THESE GENERALLY ARE FOLKS WHO SO THESE GENERALLY ARE FOLKS WHO COST A LOT TO CARE FOR COST A LOT TO CARE FOR AND WE NEED TO BE THINKING OF AS AND WE NEED TO BE THINKING OF AS A STATE, WHAT ARE WE GOING TO DO A STATE, WHAT ARE WE GOING TO DO TO HELP CARE FOR FOLKS WHO TO HELP CARE FOR FOLKS WHO REALLY NEED COMPREHENSIVE AND REALLY NEED COMPREHENSIVE AND COMPLEX CARE? COMPLEX CARE? >> IF I COULD ADD A POINT OF >> IF I COULD ADD A POINT OF EMPHASIS TO WHAT HEATHER SAID EMPHASIS TO WHAT HEATHER SAID TOO TOO WHEN YOU LOOK AT THE HEALTHCARE WHEN YOU LOOK AT THE HEALTHCARE INDICES FOR INDIANA, AND YOU INDICES FOR INDIANA, AND YOU THINK LONG TERM, THERE’S SOME THINK LONG TERM, THERE’S SOME DISTURBING TRENDS IN REGARDS TO DISTURBING TRENDS IN REGARDS TO OBESITY, SMOKING, DIABETES THAT OBESITY, SMOKING, DIABETES THAT AGAINS NOBEGINS IN ADOLESCENCE AGAINS NOBEGINS IN ADOLESCENCE SO WE HAVE A WHOLE GENERATION SO WE HAVE A WHOLE GENERATION THAT UNLESS WE MAKE SOME CHANGES THAT UNLESS WE MAKE SOME CHANGES IN THAT BEHAVIOR AND STRUCTURE, IN THAT BEHAVIOR AND STRUCTURE, WE’RE TALKING ABOUT A RETURN ON WE’RE TALKING ABOUT A RETURN ON INVESTMENT THAT WILL BE VERY, INVESTMENT THAT WILL BE VERY, VERY GOOD IN THE LONG TERM VERY GOOD IN THE LONG TERM >> HEATHER, LET ME ASK YOU ABOUT >> HEATHER, LET ME ASK YOU ABOUT THE LEGAL PIECE SENSE YOU WORK THE LEGAL PIECE SENSE YOU WORK FOR THE McKINNEY SCHOOL OF FOR THE McKINNEY SCHOOL OF LAW LAW THIS IS, OF COURSE, ONE OF THE THIS IS, OF COURSE, ONE OF THE STATES THAT SIGNED ON TO STATES THAT SIGNED ON TO CHALLENGE THE HEALTHCARE LAW CHALLENGE THE HEALTHCARE LAW BEFORE THE SUPREME COURT BEFORE THE SUPREME COURT THE SUPREME COURT BROADLY RULED THE SUPREME COURT BROADLY RULED IN FAVOR OF THE FEDERAL IN FAVOR OF THE FEDERAL GOVERNMENT EARLIER THIS YEAR GOVERNMENT EARLIER THIS YEAR ARE THIS STILL LEGAL CHALLENGES, ARE THIS STILL LEGAL CHALLENGES, DO YOU THINK OUT THERE THAT DO YOU THINK OUT THERE THAT COULD POTENTIALLY GET IN THE WAY COULD POTENTIALLY GET IN THE WAY OF STATES GOING FORWARD WITH OF STATES GOING FORWARD WITH IMPLEMENTATION OF THIS LAW? IMPLEMENTATION OF THIS LAW? ARE THERE OTHER WAYS YOU SEE ARE THERE OTHER WAYS YOU SEE THAT SOMEONE IS GOING TO SAY, THAT SOMEONE IS GOING TO SAY, WAIT, WAIT, WAIT, HERE’S ANOTHER WAIT, WAIT, WAIT, HERE’S ANOTHER POINT THAT WE HAVEN’T DISCUSSED POINT THAT WE HAVEN’T DISCUSSED YET? YET? >> YOU KNOW, NEVER SAY NEVER >> YOU KNOW, NEVER SAY NEVER BUT I THINK AT THIS POINT, IT IS BUT I THINK AT THIS POINT, IT IS FAIR TO SAY, EVEN IF THERE WERE FAIR TO SAY, EVEN IF THERE WERE LEGAL CHALLENGES BROUGHT, THERE LEGAL CHALLENGES BROUGHT, THERE WILL BE THINGS THAT NEED TO BE WILL BE THINGS THAT NEED TO BE IMPLEMENTED BEFORE THE LEGAL IMPLEMENTED BEFORE THE LEGAL CHALLENGES WOULD MAKE ITS WAY CHALLENGES WOULD MAKE ITS WAY THROUGH THE COURT SYSTEM THROUGH THE COURT SYSTEM SO AT THIS POINT, I THINK IT SO AT THIS POINT, I THINK IT WOULD BEHOOVE ANY STATE, WOULD BEHOOVE ANY STATE, PARTICULARLY AS WE’RE LOOKING AT PARTICULARLY AS WE’RE LOOKING AT INDIANA, TO ASSUME THAT WE ARE INDIANA, TO ASSUME THAT WE ARE MOVING FORWARD BECAUSE IF WE MOVING FORWARD BECAUSE IF WE WAIT ANY LONGER, WE MAY LOSE THE WAIT ANY LONGER, WE MAY LOSE THE OPPORTUNITY FOR INDIANA TO OPPORTUNITY FOR INDIANA TO REALLY HAVE OUR OWN SYSTEM THAT REALLY HAVE OUR OWN SYSTEM THAT RESPONDS TO INDIANA RESPONDS TO INDIANA SPECIFICALLY SPECIFICALLY AGAIN, AS I SAID WITH THE AGAIN, AS I SAID WITH THE EXCHANGE, JUST BECAUSE WE DON’T EXCHANGE, JUST BECAUSE WE DON’T DO IT THIS YEAR, THAT DOESN’T DO IT THIS YEAR, THAT DOESN’T MEAN THAT IN FUTURE YEARS WE MEAN THAT IN FUTURE YEARS WE LOSE THE OPPORTUNITY TO APPLY LOSE THE OPPORTUNITY TO APPLY FOR A STATE-RUN EXCHANGE FOR A STATE-RUN EXCHANGE BUT WE HAVE SOME UNIQUE NEEDS IN BUT WE HAVE SOME UNIQUE NEEDS IN THIS STATE THIS STATE AS YOU WERE SAYING ABOUT SOME OF AS YOU WERE SAYING ABOUT SOME OF THE INDICATORS, WE NOW HAVE A THE INDICATORS, WE NOW HAVE A GENERATION OF CHILDREN WHO MAY,

GENERATION OF CHILDREN WHO MAY, FOR FIRST TIME, HAVE A LIFE FOR FIRST TIME, HAVE A LIFE EXPECTANCY THAT’S SHORTER THAN EXPECTANCY THAT’S SHORTER THAN THAT OF THEIR PARENTS BECAUSE OF THAT OF THEIR PARENTS BECAUSE OF OBESITY OBESITY WE NEED TO DO SOMETHING ABOUT WE NEED TO DO SOMETHING ABOUT THAT, IN MY OPINION THAT, IN MY OPINION AND INDIANA HAS AN OPPORTUNITY AND INDIANA HAS AN OPPORTUNITY HERE TO REALLY LOOK AT THEIR HERE TO REALLY LOOK AT THEIR SYSTEM AND SEE, WHAT ARE WE SYSTEM AND SEE, WHAT ARE WE GOING TO DO FOR THE STATE? GOING TO DO FOR THE STATE? >> MARK AND NANCY, LET ME ASK >> MARK AND NANCY, LET ME ASK YOU, ARE THERE THINGS ABOUT THE YOU, ARE THERE THINGS ABOUT THE AFFORDABLE CARE ACT THAT DO NOT AFFORDABLE CARE ACT THAT DO NOT BENEFIT THE STATE EVEN IF IT’S BENEFIT THE STATE EVEN IF IT’S IMPLEMENTED BY THE FEDERAL IMPLEMENTED BY THE FEDERAL GOVERNMENT? GOVERNMENT? ARE THERE THINGS THAT YOU WOULD ARE THERE THINGS THAT YOU WOULD CHANGE THAT YOU THINK ARE NOT CHANGE THAT YOU THINK ARE NOT NECESSARILY BENEFICIAL TO THE NECESSARILY BENEFICIAL TO THE SPECIFIC CONSTITUENCIES THAT THE SPECIFIC CONSTITUENCIES THAT THE TWO OF YOU SERVE? TWO OF YOU SERVE? >> I DON’T SEE ANYTHING IN THERE >> I DON’T SEE ANYTHING IN THERE THAT I WOULD CHANGE THAT I WOULD CHANGE >> MY GENERAL CONSTRUCTIVE >> MY GENERAL CONSTRUCTIVE CRITICISM IS WAY TOO MUCH CRITICISM IS WAY TOO MUCH REGULATION REGULATION I MEAN, WE KNOW THE ACT ITSELF I MEAN, WE KNOW THE ACT ITSELF IS I THINK $1,000 PAGES OR IS I THINK $1,000 PAGES OR SOMETHING, AND FOR EVERY PAGE OF SOMETHING, AND FOR EVERY PAGE OF LAW, THERE’S ANOTHER 100 PAGES LAW, THERE’S ANOTHER 100 PAGES OF REGULATION OF REGULATION AND SO THAT’S NOT UNIQUE TO AND SO THAT’S NOT UNIQUE TO INDIANA, BY THE WAY INDIANA, BY THE WAY THAT’S ACROSS THE COUNTRY WITH THAT’S ACROSS THE COUNTRY WITH THE FEDERAL GOVERNMENT BUT WE THE FEDERAL GOVERNMENT BUT WE ARE DROWNING IN REGULATORY ARE DROWNING IN REGULATORY ISSUES HERE, IN TERMS OF TRYING ISSUES HERE, IN TERMS OF TRYING TO COMPLY TO COMPLY >> WHICH REGULATIONS ARE YOU >> WHICH REGULATIONS ARE YOU TALKING ABOUT SPECIFICALLY? TALKING ABOUT SPECIFICALLY? >> WELL, ANY ASPECT OF THIS LAW >> WELL, ANY ASPECT OF THIS LAW WILL HAVE SIGNIFICANT REGULATION WILL HAVE SIGNIFICANT REGULATION BEHIND IT, IN TERMS OF 9 DETAILS BEHIND IT, IN TERMS OF 9 DETAILS FROM THE ADMINISTRATION OF THE FROM THE ADMINISTRATION OF THE LAW, TO THE BILLING OF THE LAW, LAW, TO THE BILLING OF THE LAW, TO THE AUDITING OF THE LAW, TO THE AUDITING OF THE LAW, ET CETERA,EN ALL OF THAT ADDS ET CETERA,EN ALL OF THAT ADDS TREMENDOUS COST TREMENDOUS COST >> THE EXAMPLE OF THAT WOULD BE >> THE EXAMPLE OF THAT WOULD BE THE ESSENTIAL BENEFITS PACKAGE THE ESSENTIAL BENEFITS PACKAGE SO THE AFFORDABLE CARE ACT SO THE AFFORDABLE CARE ACT ITSELF SAID, THERE WILL BE AN ITSELF SAID, THERE WILL BE AN ESSENTIAL BENEFITS PACKAGE THAT ESSENTIAL BENEFITS PACKAGE THAT ANY INSURANCE POLICY THAT’S ANY INSURANCE POLICY THAT’S ISSUED UNDER THIS WILL HAVE TO ISSUED UNDER THIS WILL HAVE TO MEET MEET WELL, THEN IT HAD TO GO TO THE WELL, THEN IT HAD TO GO TO THE DEPARTMENT ODEPARTMENT OFDEPARDN DEPARTMENT ODEPARTMENT OFDEPARDN SERVICES FOR HEALTH AND HUMAN SERVICES FOR HEALTH AND HUMAN SERVICES TO ASSIGN WHAT THAT SERVICES TO ASSIGN WHAT THAT ESSENTIAL BENEFITS PACKAGE IS ESSENTIAL BENEFITS PACKAGE IS THAT IS ONLY ONE OF MANY OF THAT IS ONLY ONE OF MANY OF THOSE TYPES OF ISSUES THAT HAD THOSE TYPES OF ISSUES THAT HAD TO GO THROUGH THE LEGISLATIVE TO GO THROUGH THE LEGISLATIVE PROCESS TO BECOME THE AFFORDABLE PROCESS TO BECOME THE AFFORDABLE CARE ACCOUNT BUT THEN GETS CARE ACCOUNT BUT THEN GETS PASSED ON TO THE ADMINISTRATIVE PASSED ON TO THE ADMINISTRATIVE PROCESS, UNDER THE AGENCIES PROCESS, UNDER THE AGENCIES >> ALSO CHANGES IN THE SYSTEM’S >> ALSO CHANGES IN THE SYSTEM’S INFRASTRUCTURE IS IN THERE INFRASTRUCTURE IS IN THERE AND WHAT IT THAT MEAN? AND WHAT IT THAT MEAN? HOW WILL IT BE REGULATED? HOW WILL IT BE REGULATED? YEAH, THERE ARE REGULATIONS IN YEAH, THERE ARE REGULATIONS IN THERE THAT WILL COST MONEY THERE THAT WILL COST MONEY >> WE WILL HAVE TO FIND OUT HOW >> WE WILL HAVE TO FIND OUT HOW ALL OF THOSE THINGS GO, THE ACT ALL OF THOSE THINGS GO, THE ACT THAT NANCY PELOSI SAID, WE HAD THAT NANCY PELOSI SAID, WE HAD TO PASS IT TO READ IT TO PASS IT TO READ IT IT’S A COMPLEX DISCUSSION AND IT’S A COMPLEX DISCUSSION AND YOU HELPED US UNDERSTAND A YOU HELPED US UNDERSTAND A LITTLE BIT BETTER THE ISSUES LITTLE BIT BETTER THE ISSUES PLEASE SEND US YOUR QUESTIONS PLEASE SEND US YOUR QUESTIONS FOR NEXT MONTH’S “INFOCUS” FOR NEXT MONTH’S “INFOCUS” PROGRAM, THAT EMAIL IS PROGRAM, THAT EMAIL IS INFOCUS@INDIANA.EDU INFOCUS@INDIANA.EDU YOU CAN LEAVE A COMMENT YOU CAN LEAVE A COMMENT YOU CAN SEE THE FULL VIDEO OF YOU CAN SEE THE FULL VIDEO OF THIS SHOW AT OUR WEBSITE, THIS SHOW AT OUR WEBSITE, INDIANAPUBLICMEDIA.ORG/INFOCUS INDIANAPUBLICMEDIA.ORG/INFOCUS HAVE A NICE EVENING HAVE A NICE EVENING CLOSED CAPTION PRODUCTIONS www.ccproductions.com >> PRODUCTION SUPPORT FOR THIS EDITION OF “INFOCUS” IS PROVIDED EDITION OF “INFOCUS” IS PROVIDED BY HOOSIER ENERGY, PROVIDING BY HOOSIER ENERGY, PROVIDING ELECTRICITY TO CENTRAL AND ELECTRICITY TO CENTRAL AND SOUTHERN INDIANA ELECTRIC SOUTHERN INDIANA ELECTRIC COOPERATIVES AND THEIR MEMBER COOPERATIVES AND THEIR MEMBER CUSTOMERS, INFORMATION AT CUSTOMERS, INFORMATION AT ATPN.COM, AND BY WTIU