SCOTUS sparks conversion therapy controversy, ideology drives Title X changes, and Indiana’s $207M plan for rural health

Hoosier Health Matters
Season 2, Episode 12
Date: 4/10/2026
Title:  SCOTUS sparks conversion therapy controversy, ideology drives Title X changes, and Indiana’s $207M plan for rural health

0:00- Intro

1:15 - Join the Good Trouble Coalition Board

2:01- SCOTUS rules that Colorado cannot ban conversion therapy, but Gabe has complicated thoughts about this ruling

12:01- Dolly Parton's Imagination Library fully funded in all 92 Indiana counties

12:40- Tracey explains to all of us what Title X is and why new funding through Title X is bad

15:58- Match day just passed- we explain what that is and how match results demonstrate the mess that is payment incentives in medicine

21:05- Interview with Cara Veale, the CEO of the Indiana Rural Health Association about the Rural Health Transformation Grant

37:17- It is time to vote in the primary- between now and May 5th. Find your ballot and an early voting site at https://indianavoters.in.gov/

38:38- Wrap up

Become a member of the Good Trouble Coalition (free!)
Donate to support the Good Trouble Coalition

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Transcript

Tracey (00:00)
Yeah, so it's actually a federal program that's older than either of us, Gabe. It is something that was passed by Congress in 1970. Yes, yes. So it's like ancient. It's ancient.

Good Trouble Indiana (00:06)
We're even older than you? ⁓ wow.

Hello and welcome to Hoosier Health Matters for Friday, April 10th, 2026, brought to you by the Good Trouble Coalition. I'm Gabriel Bosselet, pulmonary and critical care physician and former and founding president of Good Trouble. I'm joined as always by Tracy Wilkinson, pediatrician, health services researcher and Good Trouble board member to talk about all things public health in Indiana. Hi Tracy.

Tracey (00:41)
Hi, Gabe. Are you enjoying the seventh winter?

Good Trouble Indiana (00:45)
Yeah, but it's gonna get warm soon. We are near the last frost, so we are very close. I have things to plant. I'm waiting. We're close.

Tracey (00:49)
Yeah. Well.

Yeah,

Good Trouble Indiana (00:55)
Tell me what else is new with you.

Tracey (00:55)
I know, I know.

I'm actually recording this with you from Chicago, so I'm extra cold, because it's a little bit colder and windier up here.

Good Trouble Indiana (01:05)
What are you doing in Chicago?

Tracey (01:06)
I have a meeting and it's hard to find time on both of our schedules to record. So now's the time.

Good Trouble Indiana (01:12)
Tracy, I want to remind everyone that we have a call for Good Trouble Coalition board members that will be out for another week. So if you are interested in joining the board of the Good Trouble Coalition, You'll get another email early next week about this And if you're curious as to what this means, you can always email Good Trouble, Good Trouble, Indiana.

org and set up a meeting with one of the board members to inquire us to just what we do and what the requirements are.

Tracey (01:34)
Yeah, so applications are due Friday, April 17th. Please apply or tell your friends too.

Good Trouble Indiana (01:38)
Perfect.

Yeah, we need more cool people to do this with us.

Tracey (01:44)
Okay. Gabe, are you ready to talk about the news?

Good Trouble Indiana (01:48)
Of course, as always. I can't wait. okay, no expectations, no hype. All right, let's hear it.

Tracey (01:50)
I'm not going to give it an adjective. We're just going to go straight into the news.

No hype, no hype. Okay, let's

talk about SCOTUS, the Supreme Court of the United States, issued in a ruling since our last episode that the state of Colorado cannot ban conversion therapy. And I wanted to talk about this because the headlines about it, I thought were a little misleading as to what the actual ruling said.

Good Trouble Indiana (02:20)
Yeah. Okay. I do think we should talk about this. I don't like this ruling. I'll start with that. However, and I, this is going to surprise some people. I don't think that Colorado should be able to ban conversion therapy from a governmental perspective, which is going to frustrate some people to hear me say that. But let me go through my reasoning. So my, you know, most of

Tracey (02:41)
Okay.

Good Trouble Indiana (02:44)
my positions on things like this are that government should not be regulating medical decisions, period. Right? So now you can make the argument that like, conversion therapy is, you know, is bad. And I don't disagree with that. I don't think conversion therapy is great. medical professions are a profession.

and professions are self-governing. So in my opinion, it is up to the medical profession to regulate what is within the bounds of reasonableness as far as treatments are concerned. And I stand by that. So in other words, if I don't want Tennessee or Indiana to outlaw gender-affirming care for people, then I'd also don't want

Colorado to outlaw conversion therapy for people. I just don't think that it is the government's role to be deciding what the medical profession and science should be deciding

So, I agree actually on face with this ruling. However, I do not at all agree with the reasons that were given because the reasons that were given that the Supreme Court said, and keep in mind, this is

Tracey (03:59)
Mm-hmm.

Good Trouble Indiana (04:05)
just a year after the Supreme courts of the Tennessee could ban gender affirming care, they're now saying that Colorado cannot ban conversion therapy. And this seems to me to fly in the face of reasonableness. But the way that they got around this was they said, look, conversion therapy is words. It's the therapy is talking. And this is,

protected by the First Amendment. This is an asinine.

conclusion to say that conversion therapy in the form of words is not therapy is the dumbest thing ever. This would suggest then that no one could be sued for any therapy related issues because of the first amendment. This would argue actually that medical societies and medical professions

could not.

do the thing that they're supposed to do, which is govern what seems to be reasonable within what physicians talk about and recommend. This is an absolutely as nine decision, frankly.

Tracey (05:15)
Yeah, I agree with you on the asinine part. I was disappointed that there was only one justice that dissented. That was Justice Jackson.

Good Trouble Indiana (05:23)
Me too.

Tracey (05:25)
this lawsuit was started and led by Alliance Defending Freedom, which is the same legal minds that put together the case that overturned the federal protections for access to abortion. And so I think about all the restrictions that have happened to other areas of health care, abortion in particular, that suddenly the Supreme Court does not believe freedom of speech has any

place. And I really struggle with this, this ruling because of the issues of minors. And we've talked about this, Gabe, I do think that when you have a minor who does not have autonomy or does not have the ability to say no to something and is in a situation with people with authority, a licensed therapist or, you know, a healthcare setting,

is a place where you inherently have the risk of bad things happening. And conversion therapy is one of those examples.

Good Trouble Indiana (06:28)
I agree with that fully. And that's my other issue with this ruling is that there are minors involved and that makes it really difficult. So one could ask the question, well, the difference in the minors scenario between this and the previous ruling Skirmety, the SCOTUS case about gender affirming care. We actually talked about that case in season one, episode 16 with Jane Hartsock.

And I think that the way that I differentiate these two things is this. As a general rule,

Patients and their families who seek gender-affirming care do it together as a single unit, both asking for this. It's hard for me to believe that a minor who is gay

Tracey (07:13)
Yes.

Good Trouble Indiana (07:20)
whose parents don't want them to be gay, go hand in hand with their parents to a therapist for conversion therapy. Some may, some may. And for those, I actually think conversion therapy should be available for them if that is what they truly desire and want. That's very difficult to tease out. And I would argue that most kids

Tracey (07:24)
Mm-hmm.

Good Trouble Indiana (07:49)
are not that way. I would argue most of these kids are going kicking and screaming against their own, you know, better judgment because their parents are requiring them to do that. And to me, that's the main difference between the gender affirming care where the parent and the child are both trying to reckon with this together and have decided together that this is the way forward and conversion therapy where I think most of the time the parent is taking the kid kicking and screaming.

to the therapist for this therapy.

Tracey (08:20)
Yeah, that's a really good point about how aligned they are with the goals and the values. And I think that inherently conversion therapy gave to me sends a message to everyone, even those that are not engaging in conversion therapy, that being gay or not straight is wrong.

Good Trouble Indiana (08:43)
I agree with that. And it is our job as a medical and professional community to communicate that and do it effectively. In my opinion, it is not the job of the federal government to step in there. Because if we are going to ask the federal government to step in and decide what therapies can and cannot be offered by

clinicians.

We get into this scenario where the government decides stupid shit that frankly should not be decided by the government. I just don't want the government making these decisions at all. I think it is our job as a medical profession ⁓ to do a good job of communicating why conversion therapy is bad.

Tracey (09:14)
Yeah.

Mm-hmm.

Yeah. And I think

Good Trouble Indiana (09:36)
and understand

that number one, there will continue to be conversion therapy providers, but it's our job to make sure that that number is low. And there will be continuing to be adults who want this therapy, and I think it should be available for them if they want it. And kids,

who may also agree with their parents that they want this therapy, even though we think this is bad. And I think that it should be available. I think it's our job to say, look, number one, this doesn't work. Number two, it's probably harmful and do a good job of communicating that.

Tracey (10:06)
Yeah, OK, but to play devil's advocate, the federal government, multiple state governments have definitely put their feet into the water and begun regulating stuff that we agree they should not be regulating. And so what I'm frustrated by is that there's not going to be consistency in these rulings. And there's clearly an ideology that's being protected and one that's being attacked. And that's

for me, from a legal standpoint where it's supposed to be much more uniformly applied is incredibly frustrating.

Good Trouble Indiana (10:43)
yes, this is an ideology and let's be really clear what we mean by ideology. Ideology means that this is a group of people.

legislating how they think other people should live their lives. That's what ideology is. There's a right way to live your life. and, are going to force everyone to live their life that way. Yes, this is ideological.

my entire position is that my opinion about how I want to live my life should have no bearing on how others live theirs unless it affects someone else. And to me, logical consistency requires

Tracey (11:18)
Mm-hmm.

Good Trouble Indiana (11:22)
that I think that this ruling, even though the reasoning is asinine, was the right ruling.

Tracey (11:30)
Yeah, I mean, to be determined, I think it's going to be fascinating to see what happens next and what cases are brought under the same argument next to the Supreme Court and whether they will have any legal consistency at that point.

So ⁓ look out for an episode later this season where we will have Jane Hardstock come back and talk about some of the Supreme Court cases ⁓ and probably dive into this one a little bit further. All right, I wanted to talk about something happier after that conversation, but we had a great story this last week that the Dolly Parton Library is fully funded in all 92 counties of Indiana.

Good Trouble Indiana (11:59)
Definitely.

Tracey (12:14)
big deal.

Good Trouble Indiana (12:15)
It is a big deal and huge kudos to First Lady Braun for making this happen. You know, we were frustrated when this came out of the state budget. I'm still frustrated by that, frankly. I think that this should continue to be supported by all of us as a state. But you know what, kudos to them for getting it funded.

Tracey (12:32)
Yeah, I'm excited kids get books to read because literacy is important.

Good Trouble Indiana (12:37)
Yes,

very.

Tracey (12:38)
All right. Next story is about Title X. And I wanted to talk about this because we talk a lot about attacks on reproductive health. And I wanted to flag that this is the latest attack birth control access.

Title X is a federal program where people apply for funding and use that funding to provide family planning care to those that qualify based on income at no cost or reduced They recently released the last year of funding to the grantees. And there was such backlash from the anti-abortion lobby that

In response to this backlash, the HHS spokesperson promised that this would be the fifth and final year of the funding and that they will soon be releasing a new funding opportunity that prioritizes quote, life and promotes the pro-family agenda. And I can tell you, Gabe, that they have already released the grant application, which is

70 pages long and in the grant application for a family planning program, not once is the word contraception mentioned.

Good Trouble Indiana (13:50)
Seems like a problem.

Tracey (13:52)
seems like a shift and really telling that they are looking to fund different programs. And the theory is that they're probably going to be funding crisis pregnancy centers and not licensed healthcare facilities that provide actual medical care.

Good Trouble Indiana (14:05)
Yes, 100%.

Tracy, can I ask you a basic question that's going to reveal my ignorance? I have no idea what Title X is. You talk about Title X, I hear about Title X, what is Title X?

Tracey (14:15)
Yes.

It's okay, hit me.

Yeah.

old program, older than you and I.

Good Trouble Indiana (14:32)
Older than you?

Tracey (14:33)
Yeah, it's ancient. It is from 1970. So it was passed under the Nixon administration. And it was titled the Public Health Service Act. And it was designed to provide funding to make sure that anybody who wanted family planning could access it no matter their income.

And so these clinics are designed to provide really high quality family planning care. And if you qualify based on income, it's no cost or it's a sliding scale that is affordable for those that might have a little bit to pay.

Good Trouble Indiana (15:10)
the potential changes to this program that the spokesperson for HHS talked about, perfect example, an illustration of ideology guiding regulation, right? The ideology here is that everyone should be having as many babies as humanly possible, that the right way to live your life is to have a lot of babies.

Tracey (15:22)
Yep.

Mm-hmm.

Good Trouble Indiana (15:33)
And

so they are changing title 10, the way that title 10 is administered to, to help to nudge that ideology along.

Tracey (15:42)
Yeah,

this is an incredibly targeted attack to make sure that one gender in our society is not allowed to participate in the same way that others are.

Good Trouble Indiana (15:55)
Wow, that's heavy.

Tracey (15:57)
let's talk about match day. Gabe, do you want to explain match day to our listeners for those of us that don't? Yes.

Good Trouble Indiana (16:03)
Yeah, no one knows. Yeah. Most people don't know what match day is.

If you're in medicine, match day is a very big deal. So you go to college, you go to medical school, and then you have to get a residency. And match day is the day where you figure out where you're going for your residency, which most residencies are like three to seven years.

depending on your specialty. So you select your specialty, you select what you want to do, and then you apply to all these put in your rank list, meaning I would rather, I want to go to IU first, St. Louis University second, University of Cincinnati third, like you just pick of all these places that you interviewed at. And then the programs themselves also do a rank list. So they've interviewed all these people and they put them in order. Here's the order.

launch these people and then it goes into this computer and spits out where people go and everyone adheres to this. the way it's been done for quite a long time. In fact, the match, the National Resident Matching Program, the NRMP algorithm won the Nobel Prize

2012

Okay. I'll get really wonky. the Gale Shapley algorithm, which solves problems in matching two sided markets. But yeah, no, sorry. It won the Nobel prize in economic sciences.

Tracey (17:17)
OK. So not like the Peace Prize.

Okay.

like what category did it win? Okay, keep going. Yeah.

Good Trouble Indiana (17:29)
So yeah, so then anyways,

match day is the day, literally, when everyone opens an envelope or gets an email now that says, okay, you are going to, you know, University of Nevada, Las Vegas for the next three years for your residency. that's where you go. So the match just happened. It happens, you said it every March, it happened like two or three weeks ago. And so we know where everyone is going,

Tracey (17:53)
yeah, so a few weeks after the match data gets released, right? So we learned that the good news was that 93 % of the slots for residency training were filled. However, medicine in particular had a lower match rate where 83.6 % of their

spots were filled, meaning that they have a lot of spots, that are not going to be filled. And this is important because family medicine is a field that takes care of basically newborn infants all the way to the end of people's lives. So they are truly

physicians that take care of everybody in a family. They tend to work more often in rural areas because they are able to serve everybody in a geographic area given their training. And so there's concern that a few years from now with this gap of training that we are going to have a really large shortage of

primary care providers specifically in rural areas in the country.

Good Trouble Indiana (19:17)
And you know, I don't want to get too in the weeds on this, but this is a market problem. do I mean by that? I mean that you have all these individuals making choices on what specialty they're going to go into based on incentives around salary, lifestyle, you know, what the nature of the work is. And the way that we have set up

our fee for service reimbursement incentives in the United States are such that generally

that system pays you more to do procedures than to think and provide office-based care. And so, you know, a cardiologist who does cardiac caths makes four to five times what a family practice doctor makes for what is generally the same amount of work.

Tracey (20:13)
Yeah.

Good Trouble Indiana (20:14)
And so yes, this is a major problem with the incentive structure we've set up in the United States about how we reimburse medical care. And this is going to continue until that incentive structure has changed.

Tracey (20:22)
Mm-hmm.

I also want to flag that the entire incentive in the way we reimburse medical care is based on reactiveness and not preventive health care. And so while primary care providers should be the most

highly paid individuals in healthcare because they prevent bad health outcomes from happening. They are the lowest paid people. And instead of preventing a heart attack, the person who treats that heart attack is actually compensated much more

Good Trouble Indiana (20:57)
Correct. And I fully agree with you.

And that's it for the news. Great.

Tracey (21:05)
So today for our interview, we're looking at a significant development for rural health care in Indiana. That's the $207 million federal grant recently secured to address infrastructure, mental health services, and health care access in our rural communities. While this investment is a major milestone, it comes at a complicated time for our state as we navigate federal Medicaid cuts and shifting state funding priorities.

joining us to break down what this money actually means for Hoosiers and how it fits into the broader fiscal challenges facing our hospitals and healthcare systems is Kara Veale. Kara is the CEO of the Indiana Rural Health Association and served on the task force responsible for securing this grant. Kara, thanks so much for being here.

Cara Veale (21:49)
It's pleasure Tracy. Thanks for having me.

Tracey (21:51)
Kara, I would love if you could tell us a little bit about the Indiana Rural Health Association and how you came into this work.

Cara Veale (21:57)
So Indian Rural Health Association, IRHA, is almost always what you'll hear it referred to as. We really re-exist to support rural healthcare organizations across the state of Indiana,

we have been around since 1997

We are predominantly grant funded. We support healthcare organizations throughout the state, but also have a regional presence as well. We do have a grant that serves as technical assistance for all things telehealth.

for the states of Indiana, Illinois, Michigan, and Ohio. A lot of our other grant programs cover topics like insurance coverage, maternal and infant health, tobacco cessation, substance and opioid use, mental health, and we do a lot of advocacy and lobbying both at the state and federal levels.

Tracey (22:44)
How would you describe the current state of rural health in Indiana?

Cara Veale (22:48)
Well, it's challenging to say the least. I think that there are certainly opportunities in rural health care, and that's not necessarily unique to today. You know, we tend to see older sicker patients in rural communities. We have higher rates of infant mortality. We see, you know, hospitals starting to

to close or terminate service lines because of financial struggles or difficulty recruiting workforce or a myriad of challenges that just lead to very difficult decisions that are impacting the hospitals and the healthcare systems themselves and then in turn the patients.

Good Trouble Indiana (23:24)
So, Kare, you mentioned older, sicker patients. You mentioned hospitals closing, difficulty with getting and hiring staff for those hospitals. Are there other barriers that patients in rural Indiana face that we haven't talked that you didn't mention?

Cara Veale (23:39)
Yeah, one of the biggest challenges that we hear very frequently is access. And so it might be transportation,

don't have a vehicle in order to get to a health care provider or I live so far from a health care provider that physically getting there is a challenge. There's no public transportation from my location to a health care provider. Sometimes access means that I don't have access to a specialist and I only get to see primary care. And so in order to see a specialist, have to travel significant distances

Sometimes access means I can't see a specialist if I had the technology to do so for a telehealth visit, but maybe my broadband doesn't work as well Sometimes access means I don't have access to my medications, so I don't get to

a pharmacy in time in order to get the medications after I've been discharged from the hospital or the pharmacy is only accessible during business hours and I work full time. Sometimes the my health care provider is only accessible during business hours. So the only option is to go to the emergency department when I'm sick because I can't take off work. So access has so many meanings to so many different people and it looks different in many different locations, but

it does create challenges for those of us who are trying to identify solutions because there's not necessarily one solution that's going to solve the quote unquote access issue.

Tracey (25:08)
So Kara, let's talk about this Rural Health Transformation Grant. We've actually talked about it on the podcast our state for the first year got $207 million, which is a staggering number. But for our listeners,

who might not understand the scale of federal grants and what this means on a state level. How does this investment compare to what Indiana has seen in the past for rural health?

Cara Veale (25:34)
you know, on paper, 207 million does sound staggering. And once you break it down, though, it's not.

And to a lot of people, that doesn't make sense because that is a huge amount of money. But when we look at the various initiatives that as a state, we want to incorporate over the next five years, we have lot that we would like to do with that money. But it takes a lot of

stakeholders, takes a lot of collaboration, and then it of course takes a lot of

Healthcare is expensive. Technology is expensive. And so when we look at incorporating things like telehealth programming and cardio metabolic centers of excellence and, you know, new innovative ways of thinking, it takes dollars.

Good Trouble Indiana (26:20)
So, I do want to talk a little bit about the broader context. mean, $207 million is a lot of money. It's historic, but it's coming at a time of significant federal Medicaid cuts and state-level measures that actually decrease Medicaid funding. We've seen multiple hospitals, maternity wards closed,

Some people are calling this grant a bandaid for much larger systemic losses as a result of the great big beautiful bill, Senate Bill 1 here in the state, How do you think about the optimism of this new funding with the very real financial pressures that these changes are putting on rural hospitals?

Cara Veale (26:56)
I tried to stay optimistic about it too. Like I said, healthcare really does need to start looking different. We have been a traditional fee-for-service model for decades. And we just don't have the volume in our rural communities for that type of model to be sustainable. And so when we think about...

the way we can deliver care in an innovative way. And so we can be collaborating with our schools and with our local YMCAs.

and our local community-based organizations to be identifying how we can be working together to be driving healthier communities and overall healthier lifestyles

a hospital and a healthcare organization can't necessarily fix that independently. We have to be working together. And unfortunately, we are gonna see some significant cuts in some of our federal programming.

And a lot of our rural healthcare providers rely on those programs. And we just tend to see a pay or mix that's higher and relies more on those federal programs in our rural communities. And so as we start to see cuts, we need to position our rural healthcare providers to be ready for

Good Trouble Indiana (28:12)
I'm going to ask a challenging question. A of this grant is sort of new stuff. At a time when funding for the infrastructure that's there is being cut, how does that work?

Like how do we take a system that, you know, this is a $207 million grant. But, the losses are far higher than $207 million under the big beautiful bill and the changes to Medicaid. So I'm just trying to square the circle in figuring out how this all is going to

Cara Veale (28:46)
And I'm not sure I the last five years, probably, we have seen some significant changes to mostly rural hospitals. know, OB has become a service line that has been reduced in the droves.

And unfortunately, if we continue to see the cuts, it's probably not gonna be the only service line that's cut.

And while I, while I, you know, try to remain optimistic that, different ways of delivering healthcare will offset those cuts and continue to help us maintain rural healthcare services.

I certainly am not going be the person to guarantee it.

Good Trouble Indiana (29:27)
So when the task force was meeting and thinking about where this money should go, what were the most urgent needs that kept coming up when you guys talked to people across the state?

Cara Veale (29:36)
Access was definitely one and sustaining access to health care services, maternal health and maternal and infant health came up a lot. that hospital sustainability came up quite a bit as well. So just ensuring how we continue to ensure that we keep our rural hospitals in place where they are today.

They're usually one of, if not the largest employer in a lot of our rural communities. when you see the demise or the close of a rural hospital, it's often the demise of the community. Employers tend to not want to up They want a community where their employees can access healthcare.

And so there's so many significant ripple effects from when a hospital shutters,

Tracey (30:19)
So you talked about how the interventions are going to have to be beyond just hospitals. So can you talk about what implementation of the grant now looks like as the funds have been awarded but have not been dispersed yet and what that next step is?

Cara Veale (30:36)
so the state has 12 statewide initiatives and the 12th initiative specifically is consists of 60 % of the funds and that is really intended to allow the each region to identify the greatest priority within the region and then design programming that fills the gaps and addresses the needs specific to that region.

So when I say regions, state defined eight different regions. And those regions will come together and create one regional application.

And so ⁓ they may identify within their region that access pre postnatal care, chronic conditions, transportation, social drivers of health, and technology or interoperability or telehealth, they might be the greatest needs. And so they develop solutions and initiatives that address those areas of need.

and then the state awards dollars to those organizations to implement those programs.

this grant is intended to bring a regional collaborative approach together that demonstrates a wide collaborative effort that includes as many stakeholders as possible

addressing the greatest need identified in the region. this funding is not intended to be one and done. The last thing we want to do is incorporate a program where five years from now it goes away. So we don't want to, you know, set up hospitals and health care organizations for five years and then

it ends. This is intended to be truly

Good Trouble Indiana (32:08)
When will the regions have their identified areas of need?

Cara Veale (32:12)
by May 15th, when the letter of intent is to be submitted to the state is ideally when we'll see kind of a ⁓ good idea of what projects and initiatives will be included at each regional grant application. It's not etched in stone by that point, but it'll be a pretty good idea of what will be included. And then by July 1st is when each regional grant application

is required to be submitted to the state.

Good Trouble Indiana (32:38)
And so will each region actually be funded or is it like competition between the regions?

Cara Veale (32:45)
each region will be funded. So there's base funding allocation, and then there is another bucket of money that's based on strength of the application essentially. And so you can basically earn additional dollars that

I think it's up to three million per region that is based on, know, innovativeness of your programming, strength of collaboration. if you meet those criteria, you can maximize your funding.

Good Trouble Indiana (33:10)
Kara, you talked earlier about access and a lot of access has to do with people. And I wonder how much of this is focused on bringing more healthcare clinicians, doctors, nurses, specialists into areas of rural Indiana where there may not be enough.

Cara Veale (33:27)
Yeah, it's a, it's a huge component and there are several of the other 11 statewide initiatives that have a focus on workforce, whether that is a physician or paraprofessional workforce

I think the entire state, is considered a mental health professional shortage area. And so we have the need, a significant need for mental health professionals across

the state of Indiana. And that's its own separate statewide initiative as well. So it's significant.

Tracey (33:53)
And then given your work at the Indiana Rural Health Association, how does this grant leverage technology in increasing the telehealth infrastructure within our state?

Cara Veale (34:04)
There's a couple of different avenues from a technology perspective. There's kind of the interoperability piece and then there is ⁓ the telehealth piece. So the interoperability piece is really critical for us to be able to talk provider to provider.

having the ability for medical record, EMRs to talk to EMRs in a seamless way would be ideal.

Then we talk about telehealth and that in and of itself is a wonderful opportunity to make sure that we have access to specialists no matter where you're at. And from a telehealth perspective, I think there's two mechanisms here. There's provider to patient and there's provider to provider. And the provider to patient gives us access from a rural community to a specialist when otherwise we may not be able to access it. which is provider to provider,

gives us access through our primary care, when maybe my primary care might be a conduit between patient to provider, and my primary care can still provide my care, but under the direction of another specialist.

lots of opportunity. we are moving in a way that allows us to reach the patient where they're at to overcome those access barriers that still unfortunately exist in rural communities.

Tracey (35:21)
So Kara, this grant, as well as all grants, eventually do come to an end. So how is this task force ensuring that the improvements that are made with this infusion of money and support into the rural health communities are sustained the next 20 or 30 years, especially if insurance reimbursement remains low?

Cara Veale (35:41)
Well, you know, part of the process for even applying for the funds, at least through the regional grants initiative is to include a plan for sustainability.

And so we're working very closely with the state to ensure that any of the proposed initiatives have a strong plan in place.

And then throughout the life of this entire program, we will continue to work both with the partners and with the state to make sure that they are self-sustaining once we hit that end of the five year period of performance.

Good Trouble Indiana (36:14)
Kara, why do you do this work? Why are you passionate about rural health?

Cara Veale (36:20)
Well, I live in a rural community. We've lived here for 20 years. I've always worked professionally in a rural community. This is the only thing I know.

Tracey (36:28)
so Kara, we often ask our guests if they can give one of their favorite hidden gems to visit in Indiana. What would you say yours is?

Cara Veale (36:36)
McCormick's Creek State Park. it is one of my favorite places to go.

it's actually, interestingly enough, where I RHA was was formed. So and I did not know that before I joined I RHA, but ⁓ it has always been one of my favorite places to go to just do a little light hiking and get a little outdoor experience. But it's beautiful and kind of just a little hidden gem.

Tracey (37:01)
Kara, thanks so much for joining us. It's so rare to see such a tangible win for Hoosiers, and your leadership on this task force is clearly going to leave a legacy for years to come. So thanks for joining us today.

Cara Veale (37:12)
It's my pleasure Tracy. Thanks for having me.

Good Trouble Indiana (37:16)
Tracy, little things or good vibes, what are you gonna pick?

Tracey (37:21)
I'm going to say a little thing for everybody who has already checked their registration to vote because we told you to do that. I am encouraging people to vote early in the primary election. It is open now. And election day is May 5th, but you can vote early now.

So it's really important to vote in the primary. You should vote in every election, but especially the primary.

Good Trouble Indiana (37:42)
thing is going to be similar to that. So I'm not ready to vote, partly because there are contested primary elections in my district that I need to do some research on. So if you're not yet ready to vote in your primary, that's fine.

⁓ What you need to do is go to the Indiana voter portal and it will show your ballot and at least you're going to pull either a Democratic or Republican ballot, one or the other. So you click on which one you want and it will show you what your ballot looks like, who's on that ballot. So my job for you for this week is to pull that ballot. And if there are, so if there are choices there in the one that you pull, you need to do some research and figure out which person you're going to support in that primary.

That's step number one. then Tracy said, and she's right, anytime between now and May 5th, you can go and vote in the primary. you can actually also find your early voting sites at the Indiana Voter Portal as well. We'll put the link to that voter portal in the show notes.

Tracey (38:38)
Yeah.

OK, so if you enjoyed this episode, please subscribe, rate, and review us wherever you get your podcasts. Also email us with your thoughts and issues you think we should be covering at goodtrouble at goodtroubleindiana.org. If you aren't already a GTC member, please become one by visiting our website. It's free and easy, and we promise to not overwhelm you with emails. Also consider becoming a donor. Even $20 a month is helped to support and grow this work.

You can find the links to join and or donate in the show notes. You can also follow us on social media on Blue Sky, Facebook and Instagram. Please look for our next episode two weeks from now on April 24th, where we will continue to discuss health policy happenings at the State House and all other things public health. Thanks again for joining us. Until next time, be safe.

Good Trouble Indiana (39:23)
And be kind.