House Speaker Brian Bosma, R-Indianapolis, announced last week that should Republicans keep their House majority following the Nov. 4 elections, they will address Indiana's nearly worst in the nation infant mortality rate only by promoting incentives for local hospitals to reduce it.
"We could create a government program, many are created every year, but it's been my experience as a leader for the last 14 years that many times those government programs don't get done what the private sector and the nonprofit sector can," Bosma said.
That's a sharp contrast to Republican Gov. Mike Pence, who has directed the Indiana State Department of Health to do everything it can as part of an "all of the above" strategy to shrink the number of Hoosier children who die before their first birthdays.
"Infant mortality is considered the number one indicator of health status worldwide. Yet Indiana consistently ranks worse than the national average and goals," Pence said at his 2013 infant mortality summit. "Indiana must do better."
To that end, Pence has deployed his $9.1 million Management and Performance Hub data team to scour state health and socioeconomic records looking for connections that might lead to better state programs aimed at reducing infant mortality.
He's also hosting a second infant morality summit Nov. 13, bringing together public and private sector forces to share ideas for outreach to new mothers and other strategies to prevent early childhood deaths.
At the same time, Pence's state health department isn't waiting for data or summit results before acting.
Next month, it will launch a $1.3 million "Labor of Love" television, radio and online advertising campaign to discourage pregnant women from smoking and new mothers from sleeping in the same beds as their infants, who can be smothered if a parent rolls on top of them.
Bosma did not answer when asked if House Republicans would seek to end funding for Pence's government-led infant mortality prevention efforts when the Legislature convenes in January. Earlier this year, they killed a state-managed energy efficiency program in favor of utility-run energy savings plans.
While Bosma acknowledged infant mortality is a serious problem "that should give us all pause," he insisted a "private sector solution with public sector incentives" is the only way to tackle it.
"For instance, if you gave a hospital a ZIP code area where there were particular issues in this regard, and they're not just in the minority communities but it's in minority and low-income areas, and told them, 'If you can address this issue and move the dial significantly on infant mortality in this Zip code or whatever your geographic area is, we will reimburse you 1 percent more for Medicaid purposes.'"
"Suddenly we have an incentive to place a clinic, to do education, to talk to expectant or recent mothers about prenatal and postnatal care, and to get folks who don't have access to health care in front of a doctor or a nurse practitioner or another health care provider that can give them information," Bosma said.
Research shows infant mortality primarily is caused by a lack of access to health care, smoking during pregnancy that results in low birth weight babies and other factors generally related to a mother's low educational attainment or poverty.
Pence and Bosma both have ruled out expanding Medicaid eligibility under the Affordable Care Act or increasing cigarette taxes to discourage smoking. They also are in the process of restructuring Indiana education to focus on career training instead of lifelong learning.
In addition, the Republican-dominated Legislature annually enacts new restrictions on abortion, which likely increases the state's infant mortality rate as women unable, unwilling or unprepared to care for a child are more or less compelled to give birth.
House Democratic Leader Scott Pelath, D-Michigan City, said until Republicans care about improving the prosperity of all Hoosiers, instead of just businesses and the wealthy, Indiana won't be able to improve its infant mortality rate since it is so closely tied to poverty.
Indiana ranks 45th in the nation for infant mortality with 7.7 children out of every 1,000 dying before their first birthdays. Illinois' rate is 6.52. The national average is 6.07.
The only states with higher infant mortality than Indiana are Alabama, Delaware, Louisiana, Mississippi and Ohio.