Why does Indiana always rank low in national health care?

This article is published as part of a collaborative effort by students in the School of Journalism and Strategic Communication at Ball State University and the Ball State Daily News. Produced in a classroom setting under faculty guidance, the initiative aims to provide hands-on experience while informing the public through responsible, student-driven journalism.

When Anna Payne was told Indiana has ranked in or near the bottom 10 United States in health care for her entire life, she was not surprised. A lifelong Muncie, Indiana, native, Payne has battled Crohn’s Disease since she was 9 years old. Now 27, Payne also has Postural Orthostatic Tachycardia Syndrome (POTS), Gastroparesis and Mast Cell Activation Syndrome (MCAS).

POTS drastically raises a person’s heart rate when they quickly stand up or sit down, meaning Payne’s body often has trouble keeping a steady blood pressure rate. Gastroparesis causes Payne’s stomach muscles to not contract or move as they should during food digestion. After years of struggling with Gastroparesis, Payne had a procedure to insert a feeding tube through her nostrils leading into her stomach, which she now uses for every meal.

While Payne has been officially diagnosed with POTS and Gastroparesis, her battle against MCAS is self diagnosed. MCAS often causes unexplained episodes of hives, swelling, vomiting and more by the body’s mast cells falsely alerting the immune system that there is something harmful in its system. Payne takes medication to ease her persistent nausea, and while she has been offered other medications to deal with her compromised digestion, she believes the negative side effects of most of the medications outweigh the benefits. Many of Payne’s six daily medications cost anywhere between $90-120 per month.

While Payne is grateful for the care she has received during her near 20-year struggle, she knows her quality of life could be higher if she chose to live elsewhere. According to a 2020 study conducted by Nir Menachemi and Paul Halverson for Indiana University (IU) Indianapolis’ Richard M. Fairbanks School of Public Health, Indiana ranked bottom 10 nationally for health care categories such as vaccinations, mortality rate (infant included), obesity rate and smoking rate. In the five years since, Indiana is still among the worst 10 states for those areas.

Dr. Ryan Johnston has been a medical professional since 1998, employed by IU Health since 2000. The Chief Medical Officer for IU Health Ball Memorial Hospital believes Indiana has stayed stagnant in its low healthcare ranking due to its relatively low health literacy compared to the rest of the United States. For example, despite education on the negative effects of smoking starting early in most Indiana school systems, the state still ranks seventh in national smoking rates, according to the Indiana Division of Mental Health and Addiction.

Johnston correlated Indiana’s habit of smoking with its ninth-highest national Lifestyles Habits & Health Outlook and Disease Risk Factors & Prevalence scores, according to a 2024 study completed by Cassidy Horton and Korenna Bailie of Forbes Advisor. For non-smokers, Indiana also ranks as the 12th-most obese state in the country with 69.6% of adults in the state categorized as such, according to a 2023 study by the Indiana Department of Health.

Despite efforts against these rankings, Johnston has admitted that health professionals in Indiana could have made things easier on state citizens since the turn of the millennium, boiling it down to two issues: convenience and staff.

Johnston said he and the rest of IU Health Ball Memorial Hospital’s Board of Directors have discussed making specialists available during times other than Monday-Friday from 9 a.m. to 5 p.m. so those with day jobs wouldn’t always have to call off work in order to see a doctor.

With these obstacles in mind, that has not prevented Johnston and the IU Health ECI region board of directors from discussing ways to improve Indiana’s national health care ranking in every meeting they conjure. In fact, Johnston said he discusses the topic with his co-workers daily.

“That's all we talk about: trying to find ways to maximize access, to make it more efficient, to improve it,” Johnston said.

Though these issues have failed to be consistently addressed statewide, it is not for a lack of spending. A 2024 study helmed by Menachemi, Aparna Soni and Lindsey Sanner for IU Indianapolis’ School of Public Health revealed Indiana’s total per capita health spending is nearly equal to bordering states and the national average. Spending has even risen in single-plan, employer-plan and family-plan insurance packages to no avail.

While she has only been off her parents’ insurance plan for a little more than one year, Payne asked to be included in conversations about her medical billing when she turned 18; she wanted to know how to be prepared when it came time to take care of her own insurance.

Payne ultimately chose a Preferred Provider Organization (PPO) plan with the lowest deductible possible. However, this means Payne’s plan has the highest coinsurance rate and premium (one she pays biweekly) of any she considered. She believes her choice was ultimately worth it due to how much she has to use her insurance to pay for daily essentials, such as feeding tube supplies, which cost up to $4,000 per month.

“Is it fun to spend when I know that money could go towards a vacation or something, but it's going towards health? No; but, it's what I gotta do,” Payne said.

Payne said she holds no hostility toward any doctor or medical specialist she has seen over the years, but that doesn’t mean her journey has been without frustration. The waiting game has been Payne’s largest annoyant.

She said there have been many times in which she travels to a pharmacy to pick up medicine only for that prescription not to be filled yet. When Payne asks if there is any way she could get the prescription that day, she is told she would have to pay full price without insurance coverage due to asking for the medicine in advance. In a more extreme instance, Payne’s waiting was seemingly pointless only to cost her more money.

“When I got my feeding tube, I had to stay in the hospital an extra day because Anthem hadn't approved the supplies to get shipped to my house,” Payne said. “After I got back, Anthem decided to say, ‘She stayed too long in the hospital; we're not covering the whole stay.’ But, I was there an extra day because they hadn't approved something.”

During the time while she waited to see a new gastroenterologist that could get plans in motion to grant her a feeding tube procedure, Payne dealt with some of the worst health issues of her life practically alone. She remembered taking extended periods of time off work, no-showing gatherings with her friends and mostly laying in bed all day due to her lack of strength.

“You’re just thinking, ‘When will this stop?’” Payne remembered. “I’ve trusted doctors, but sometimes I’d be like, ‘Can I really wait this long?’”

It took nearly a year for Payne to see her new gastroenterologist, which led her to believe there are not enough doctors or health care resources made available in Indiana. However, Johnston said a significant number of health professionals leave the field due to burnout or other reasons unspecified to him in the aftermath of the COVID-19 pandemic.

Filling those positions has not been an easy task, with Johnston citing numerous times when his IU Health region seemed to be on the brink of a hire only for that candidate to choose another hospital instead. In attempts to replace former employees who had tenured positions, oftentimes IU Health has to move from someone with more than two decades of experience to those in their first professional role out of college.

Despite the long wait, Payne never considered going out of state for an earlier procedure due to out-of-network costs being too high for out-of-state appointments. She realized she may have missed out on better health care made available in these neighboring states.

For 2024, U.S. News and World Report found that three of the four states bordering Indiana ranked above the Hoosier state in health care with Illinois ranked 28th, Michigan 29th and Ohio 35th while Indiana slotted in at 41st. Data contributing to these rankings included the accessibility and quality of health care in each state, as well as the state’s health outcomes in areas such as those outlined by the IU Indianapolis School of Public Health.

Since taking office as Indiana’s 52nd governor in January 2025, Mike Braun and his team have signed numerous healthcare-related executive orders in a push to improve Indiana’s long-lasting low healthcare ranking. Some orders plan to enact statewide audits of healthcare spending to ensure taxpayer dollars are not wasted, while others aim to address price transparency, something IU Health has done since making their pricing scale available online since 2021.

Braun and the Indiana government as a whole may be fighting an uphill battle when it comes to improving the Hoosier state’s rank as the 10th-least healthy U.S. state, though that is not due to a lack of want-to from the decision-makers for large hospital networks throughout the state.

“Streamlining some of this, making things more efficient, holding folks accountable to the cost of care is everyone's responsibility,” Johnston said. “We in the healthcare industry have not always been real forthcoming. You can say in a mission statement that you want to do something, but unless you are specifically putting in place a plan and strategizing tactics to do that, then it's just a dream at that point. There's an understanding [at IU Health] that for our state to be both well and economically well, we need to improve.”

Despite issues such as smoking and obesity rates still persisting, Johnston is confident significant healthcare improvement in the Crossroads of America is attainable within the next decade.

Contact the Ball State Daily News via email at editor@bsudailynews.com.

Read More

Ball Brothers Foundation awards over $3 million worth of grants

By Staff Reports / Yesterday

The Ball Brothers Foundation has awarded over $3 million worth of grants this spring to various community initiatives, according to a press release from the foundation. 

---

Counters against low-Income healthcare barriers exist for Muncie and other Hoosiers

By Zach Gonzalez / 2 days ago

According to America’s Health Rankings data, Indiana ranked 27 out of 50 in states with the most uninsured citizens in 2023, and income inequality had the largest cause in Indiana on overall health, based on a 2024 annual report on the state’s public health from the same organization. 

---

Something for Everyone: Stitch, Resist, Slice, and Explore

By Ball State Daily / 2 days ago

Looking for local ways to meet new people, enjoy hands-on experiences, or just try something new without breaking the bank? From community crafting at The Cup to geode slicing at Kat’s Crystals, Muncie offers a full week of inclusive, engaging events. This roundup highlights free and low-cost happenings from June 15 to 21. The events include a progressive social mixer at Guardian Brewing Co., a no-questions-asked food tailgate at Callaway Park, an educational stroll through Minnetrista’s pollinator gardens, and more. Whether you want to stitch, resist, slice, or simply explore, there’s something in town for everyone.