What Has Mike Pence Done in Health?

WASHINGTON — When President Trump announced Wednesday that Vice President Pence would take charge of the nation’s coronavirus response, he repeatedly touted the “great health care” in Indiana during Mr. Pence’s time as governor there, adding, “He’s got a certain talent for this.”

So what does Mr. Pence’s record on health care look like? He has no training or expertise in health policy. Paradoxically, the two health initiatives that he got the most attention for in Indiana are actions that many in the Republican Party have strongly opposed.

In 2015, he was one of the first Republican governors who agreed to expand Medicaid under the Affordable Care Act, a move that others in his party have shunned because of their opposition to the law.

That same year, he allowed — albeit reluctantly — a program to provide clean needles for intravenous drug users in a rural county that was in the throes of an HIV outbreak.

For weeks, Mr. Pence delayed permitting public health workers to distribute the clean needles to slow the epidemic, stating moral opposition to drug use. He relented as the number of HIV cases approached 100 (they ultimately surpassed 200) and doctors from the Centers for Disease Control and Prevention pleaded with him — and after taking a few more nights to “pray on it,” according to Dr. Jerome Adams, the state health commissioner at the time and now the United States surgeon general.

Today, his decision to allow a needle exchange — initially only for 30 days — is believed to have played an important role in slowing the epidemic.

But while his decision allowed such exchanges to open statewide, no state funding was made available for them. More broadly, critics said that Mr. Pence, like previous Indiana governors, had failed to invest adequately in public health.

“All his public health policies in Indiana were more about his beliefs or ideology, and not evidence based or around data,” said Carrie Ann Lawrence, associate director of the Rural Center for AIDS/STD Prevention at Indiana University.

As a member of Congress from 2001 to 2013, his deep opposition to abortion led him to initiate efforts to strip federal funding from Planned Parenthood. A Planned Parenthood clinic had been the only place for HIV testing in Scott County, where the outbreak took place. It closed in 2013, largely due to cuts in state public health funding.

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A 2018 study from researchers at the Yale School of Public Health estimated that putting in place a robust public health response, including needle exchanges and stepped-up HIV testing, in 2013, when Mr. Pence took office and opioid abuse was quickly growing in the state, would have averted dozens of HIV cases.

Mr. Pence initially refused to expand Medicaid as other, mostly Democratic-led states hurried to do so in 2014, when the Affordable Care Act started giving them the option to do so with the federal government paying nearly all the cost. But he ultimately persuaded the Obama administration to let him expand the program on his own terms, including some that had not been allowed before under federal rules. Mr. Pence designed the plan with Seema Verma, then his top health policy adviser and now the administrator of the Centers for Medicare and Medicaid Services.

Under his program, called Health Indiana Plan 2.0, low-income adults above the poverty level had to pay monthly premiums equaling two percent of their household income, instead of receiving care entirely for free. In a first for the Medicaid program, they could be disenrolled for six months if they failed to pay. Newly eligible adults below the poverty level did not have to pay premiums, but got more health benefits if they did.

“It gives Hoosiers the dignity to pay for their own health insurance,” Mr. Pence said at the time, “and that transaction is important to starting people on a path toward really embracing greater ownership of their health care.”

A state evaluation in 2017 found more than half of those who signed up for the program and were supposed to pay premiums during the first two years failed to do so, most before their coverage even kicked in. Many said the program was confusing as well as unaffordable.

Still, from 2013 to 2016, Indiana’s uninsured rate fell by 7 percentage points, more than both the national average decrease of 5.2 percentage points and the 5.5 percentage point decrease in all Medicaid expansion states, according to the Kaiser Family Foundation, a health policy research organization.

The expansion was approved just in time to provide health coverage to people newly infected with HIV as a result of the outbreak.

“Through the Health Indiana Plan model of Medicaid expansion, we learned firsthand the immense value of health insurance as a tool for responding to public health crises,” said Susan Jo Thomas, executive director of Covering Kids and Families of Indiana, a nonprofit group that advocates for health coverage. “We are all grateful that Indiana has the HIP program.”

A staunch conservative and evangelical Christian, Mr. Pence was also known for promoting anti-abortion legislation during his time as governor, including a law that, among other things, required that miscarried or aborted fetuses be cremated or interred. Women expressed outrage about the law on social media in a campaign that became known as #periodsforpence.

In brief remarks on Wednesday evening after Mr. Trump announced his new role, Mr. Pence mentioned only one experience handling a public health crisis: the first domestic case of Middle East respiratory syndrome, a highly infectious and dangerous virus known as MERS, in 2014, in an Indiana health care worker who had recently returned from Saudi Arabia.

At the time, the C.D.C. praised the hospital where the patient had shown up in the emergency room for its infection control, including its rapid isolation of about 50 hospital workers who were exposed to the patient. Mr. Pence’s role was largely receiving updates from the state health department. According to the Fort Wayne Journal Gazette, he also held a news conference at the hospital, in Munster, a few days after the diagnosis, “partly to show that it was safe to be there.”

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