Indiana is staying in Stage 5 of its reopening, Gov. Eric Holcomb said, until at least mid-November. The state is facing more coronavirus cases and hospitalizations.
Nine months ago, before most people had even heard of the word “coronavirus,” Dr. Woody Myers announced he would run for governor, focusing on education, jobs and health care. No one knew that last pillar would come to dominate our lives with a microscopic germ that would upend our economy and kill thousands.
Myers, who served as state commissioner of health under a Democratic and then Republican governor, might seem to have the perfect resume for assuming the helm amid a pandemic.
But if Myers has the formal training, incumbent governor Eric Holcomb has had the real-life trial by fire. Over the past six months he has mastered terms such as positivity rate and PPE while repeatedly exhorting Hoosiers to take steps to lower viral spread, such as social distancing and wearing masks. He put in place a statewide mask requirement, though without any penalties for failing to do so.
While Myers criticizes Holcomb for not taking bold enough steps to halt the virus, Libertarian gubernatorial candidate Donald Rainwater said Holcomb has done too much. A poll last month by Indy Politics and Change Research found Rainwater 12 percentage points behind Holcomb with Myers in the middle. Pundits speculated that Rainwater was gaining support from those who oppose the mask mandate and shutdown of businesses.
No matter who wins on Nov. 3, whoever is governor will need to deal with a host of things beyond what stage of reopening Indiana needs to be in. He will need to lead during a pandemic that is not likely to end for at least another year. At the same time, depending on what happens at the federal level, he may have to handle changes in the Affordable Care Act that could affect low income Hoosiers’ access to care.
Libertarian candidate: Donald Rainwater targets voters upset by COVID-19 mandates
At this moment, to what degree to reopen is the center of attention.
On Wednesday Holcomb said Indiana would remain in Stage 5 despite a record number of cases and rising positivity rates and hospitalizations.
The governor called on Hoosiers to remain vigilant, wear their masks, maintain social distance, and practice good hygiene to curb viral spread. Throughout the past seven months, he has spoken repeatedly about the need to balance lives and livelihoods.
Shutting things down once more would be “missing the point,” Holcomb said, pointing to contact tracing indications that individual behavior is driving the recent surge. State officials will assist counties that have the highest spread and discuss steps they can take to turn the numbers around.
In a press availability Thursday, Myers said he would like to see the state move back to Stage 4 and perhaps Stage 3 in some places, which are seeing the greatest viral spread. He charged that Holcomb was letting politics shape his decisions and reiterated his call for a mask mandate with teeth.
“We must protect Hoosiers with public health in mind, not the outcome of an election,” Myers said.
In an hourlong interview in late September, Myers spoke at length of many of the state’s most pressing health issues. Rainwater also shared his approach in a phone call. Holcomb declined to give an interview but provided in-depth answers to a number of questions in an email. Here’s what the candidates had to say:
On the coronavirus pandemic
While Holcomb defends his record, Myers, who also had a stint as the health commissioner of New York City, says one only needs to look at the Northeast, which stayed closed long after Holcomb’s Back on Track plan began, to see that Indiana could have done better. Myers noted that Indiana’s positivity rate in late September was several times that of New York City.
“That’s where we should have been and we could have been if we were aggressive,” Myers said.
Myers faulted the state’s response on several fronts, including taking too long to set up a state infrastructure for testing. Even once a system was place, until recently one of the largest cities in the state, Gary, had no Optum testing site, Myers said. The state also should have provided clearer guidance on reopening to schools, which in many cases opened prematurely, jeopardizing the health of teachers, he said.
Democratic gubernatorial candidate Dr. Woody Myers serves food to homeless people at Lugar Plaza in Indianapolis on Sept. 3. (Photo: Michelle Pemberton/IndyStar)
“My priority is public safety, and public health is a part of public safety,” Myers said. “All other things will be second. If people are not alive, the economy is irrelevant.”
But Holcomb defended what he has done, saying that he is proud of the way the state’s team has managed the global pandemic. He said in an email that the state has supported Indiana’s small business community, creating a personal protective equipment marketplace to ensure that businesses had what they needed. The state used $30 million in federal CARES Act funding for the Small Business Restart Fund. Indiana has dedicated $10 million to support the manufacturing industry and another $10 million to tourism.
However, what he said he was most proud of when it comes to Indiana’s pandemic response is the sense of community that he has noted throughout the state: people shopping for groceries for their elderly neighbors, businesses offering meals to front line workers and breweries and distilleries pivoting to make hand sanitizer.
State, federal and local governments, nonprofits and the private sector collaborated to manage their way through the pandemic, he said. The state rapidly set up a testing infrastructure with more than 250 sites and provides the public with data through its online dashboards.
Throughout, he said, he has taken a “measured, data-driven approach that’s balanced lives, first and foremost, and livelihoods.”
“We’re proving you can go back to work and back to school safely,” he said, adding as he often does in public appearances the caveat that we are not back to normal but must continue to be vigilant, wear masks, physically distance and practice good hygiene.
Local public health experts have praised Holcomb’s pandemic response.
In a wise move, he left some decisions up to local public health officials, something that the governors of other states such as Texas, Georgia and Florida did not do, said Ross Silverman, a professor of health policy and management at the IU Fairbanks School of Public Health.
Without clear guidance from the federal sector and no clear playbook on how to respond, pandemic response has posed an unprecedented challenge for state leaders.
“Arguably this is the most complicated public emergency we have had to deal with. It’s not like a tornado that affects a county or a community. This is affecting every corner of the state,” Silverman said. “That creates a significant challenge, especially when there hasn’t been consistent national messaging and consistent national funding.”
On whether to mask or not
Masks have been one of the more controversial aspects of the pandemic response. They have become politicized. Holcomb said that he understands that people are tired of them. But just as he has said on repeated occasions, he added that they work.
In July the governor demurred at instituting an order they be worn in public, first implementing a campaign that urged people to do so. Three weeks later, he issued an order.
“It wouldn’t have hurt if we did it sooner, but we did it when the data took us in that direction,” he said. “To me, masks are like seats belts, only better, in that they play offense AND defense. … What I must continue to do relentlessly is educate, ask others to do so as well, and say the more that we do this the more effectively we slow the spread. If you mask up, we can stay open.”
But Myers said that Holcomb flubbed the mask issue, analogizing the public health imperative behind masks to the risk of second-hand cigarette smoke. In the latter case, the government eventually restricted smoking in public places, making overall public health the primary concern.
That should have happened with masks, Myers said. Instead, Myers said, the governor waited until his predecessor, Vice President Mike Pence, donned a facial covering to put in place a mask order in Indiana that has no teeth, pandering to the anti-mask coalition in the state.
“We don’t have a mask mandate in Indiana; we have a mask suggestion,” Myers said. “We have no backbone or spine behind it. People flaunt it every day.”
Rainwater, the Libertarian candidate, said he thinks Holcomb already has gone too far. The decision to wear a mask should be a personal one, said Rainwater, who said he covers his face wherever he is required to do so.
When Holcomb put the mask order into effect, he cited scientific studies that showed that wearing a mask can protect you from infecting others if you yourself have coronavirus.
But Rainwater said Holcomb should have been specific about which studies he was referencing. He questioned what changed about the science in the three-week period between Holcomb’s strongly urging Hoosiers to adopt the practice to his mandating it.
“Many people are reacting adversely because what’s being mandated by government isn’t common sense and isn’t logical. They say it’s based on science, but they don’t show us science,” he said. “Why can’t you just show me the information and let me make the choice myself?”
Attaching penalties to the mask mandate might only have wound up disproportionately affecting the poorest people in the state, Silverman said, as has been seen in other areas of the country that took that step.
Nor would more stringent restrictions necessarily have had the desired effect, he said.
“In a state like Indiana we have always tried to take an approach where we empower and educate citizens to do the right thing under the circumstances,” he said. “Coming in with sticks in this as opposed to trying to encourage people probably would have backfired worse.”
Future of HIP and ACA
Shortly after Election Day, the U.S. Supreme Court is scheduled to hear a case that could strike down the Affordable Care Act, which led to the expansion of Medicaid in many states.
When the ACA passed, the state already had in place its Healthy Indiana Plan, which aimed to provide low-income residents with health insurance. The federal government granted Indiana a federal waiver that allowed it to maintain the plan and also extend its reach. HIP, which requires some people to make minimal financial contributions, is now recognized as a model state health care program, Holcomb said.
“I don’t know what will happen at the federal level, but I have said before and I will say it again, I am committed to ensuring HIP remains in Indiana,” he said. “Having HIP, and what we have been able to do in our state, has gotten us to a point where no matter your income, in Indiana there is a healthcare option available for you. If you’re uninsured in Indiana, you shouldn’t be.”
Holcomb said that he is asking the federal government for a 10-year waiver to continue the program.
In keeping with the ideals of the Libertarian party, Rainwater said that he is not an overall fan of government-provided health care. Instead, he said, he would like to see a system where people do not need to turn to the government for their insurance.
“That said,” he said, “I will make absolutely certain that the people who need and get the HIP plan have it until we have things that are better and more affordable.”
While Myers said that it’s better to have the Healthy Indiana Plan than not to have it, he said he thought the state could do more to expand the plan to reach additional individuals, particularly children who lack coverage.
About 100,000 children in the state have no coverage, he said.
“That’s 100,000 too many,” he said.
Myers also took issue with the Holcomb administration’s attempt to attach a work requirement to HIP, a requirement currently making its way through the courts. Similar to Republican efforts to dismantle the ACA, Myers said, the party is being disingenuous when it tries to put in places such measures.
In reality, he said, many Republicans don’t even want to roll back the program, nicknamed Obamacare, but they want their supporters to think they do.
Indiana’s attempt to institute a work requirement for HIP “is a dog whistle for people who think people are getting away with something; it’s just crazy,” he said. “It’s another thing that they say that they’re upset and want to do something about but they really don’t.”
Holcomb’s administration receives mostly praise, however, from some in the nonprofit sector. Although she said she was not endorsing one candidate over the other, Susan Jo Thomas, president of the Indiana Public Health Association, said the administration has done many progressive things during Holcomb’s tenure.
Thomas, who is executive director of Covering Kids and Families, cited a program that helps people financially as they transition off HIP to commercial insurance. She also noted the state’s recovery network for people with substance use issues that is part of HIP.
“They have been reactive in ways that I have not thought of,” she said of Holcomb and the secretary of the Family and Social Services Administration, Dr. Jennifer Sullivan.
However, she said that she would like to see the state address one of the disparities that has arisen with HIP. Many people of color who are enrolled in the plan have a lower level of coverage, with more cost sharing and fewer benefits. HIP plus enrollees, who enjoy additional benefits such as dental and vision, are predominately white.
Indiana also could do better on several health measures, including improving the state’s infant and maternal mortality rates, Thomas said. Because Medicaid covers the majority of births in Indiana, the state could invest more in prenatal care to improve those metrics, she said.
Indiana also ranks among the states with the highest smoking rates. Increasing the cigarette tax to dissuade smokers and putting the additional revenue into public health could both lower smoking rates and improve health overall, she said.
Public health measures and infrastructure
Holcomb registered a recent win earlier this month. The state announced that its infant mortality rate had fallen to its lowest point ever, 6.5 babies per 1,000 live births.
“That means more Hoosier babies are celebrating their first birthdays than ever before,” he said. “I’ve made a lot of announcements as governor—jobs announcements, judicial announcements, infrastructure announcements—but announcing the lowest infant mortality rate in recorded state history was, by far, the best.”
The national infant mortality rate is below 6 babies per 1,000 live births, and Holcomb said that while the state has made progress, he plans to continue working in this area. Indiana already has taken steps to provide pregnant women with additional support, such as as expanding the nurse-family partnership, which offers wraparound services to those expecting.
Holcomb also advocated for passing accommodations for working pregnant women, an effort that did not pass but one on which he promised to continue working.
One thing Holcomb said he will not be working for in the immediate future is increasing the cigarette tax.
“We’re in the middle of a global pandemic and now’s not the time to raise taxes on any Hoosier,” he said.
Under his administration, he said, the state has taken other steps to encourage people not to smoke, such as offering more tobacco cessation services, raising the smoking age to 21 in keeping with a national mandate to do so, and increasing penalties on entities that sell tobacco products to minors.
But Myers is not impressed with Holcomb’s record. He said that he entered the race to help improve Indiana, his home state, and bring with him his years of experience as a health care executive.
“Indiana is an unhealthy state, and we need to do a lot better,” he said. “Indiana is like an undiagnosed, untreated patient. I want to do the history, physical examination, and prescribe the right treatment.”
Unlike his opponent, Myers supports raising the cigarette tax, a measure that he said also will help decrease the rate of infant mortality as many of the people who smoke in Indiana are pregnant women or their partners.
Indiana also can do more to decrease maternal and infant mortality by addressing the 33 counties in the state where no prenatal care is available and by instituting a program such as the one in California where doulas assist pregnant mothers before, during and after childbirth.
Overall, Myers said, he would like to see Indiana invest in public health infrastructure. National rankings typically put the state at the bottom of the pack on this measure. Republicans have had 16 years to address this with a long-term investment in public health, Myers said.
“It’s time for Indiana to do things differently,” he said. “For many years, we have had this attitude as a state: It’s good enough. That’s the wrong philosophy. Good enough is no longer good enough.”
Holcomb did not disagree that the state could place more of an emphasis on supporting public health initiatives. He also noted the state has made progress on not just the infant mortality rate but also smoking rates and addressing the drug epidemic. These results prove his willingness, he said, to invest in areas that will affect Hoosiers.
But, he said, the state cannot do this on its own.
“This is an area where we needed focus on not just more money in the system but more collaboration — including many times from the patient,” he said. “For as many economic, infrastructure, government efficiency rankings where we’re at or near the top, there’s too many health rankings where we’re not.”
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