State refused to produce child-separation data, even after counties did

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MADISON – A state agency would not release county data to explain why children are removed from their homes in Wisconsin, information that eventually showed that parental drug abuse is a growing factor.

Interest in the data stemmed from a previous report that drug and alcohol abuse was splitting more central Wisconsin families and stressing caseloads. USA TODAY NETWORK-Wisconsin sought to learn from the department, which oversees child protective services, whether the trend was isolated or widespread across the state.

But the agency responded with roadblocks.

A department spokesman initially said the agency doesn’t track the reasons that children are taken from their parents (which is untrue). Then the state said county-level statistics couldn’t be exported from the agency’s records system (also untrue).

Finally, the public agency decided that compiling the data wasn’t worth staff time.

“We do not have the manpower to undertake such an endeavor,” Joe Scialfa, the department’s communications director, wrote in a January email.

The news organization had asked the Department of Children and Families to provide caseload data showing the number of drug-related child separations for each of the state’s 72 counties. In other words, how often was drug abuse being flagged by social workers as a contributing factor in a separation?

After the state refused to the compile the data from every county, USA TODAY NETWORK-Wisconsin asked child welfare officials from 16 counties to produce data from the state records system. A few counties initially insisted that providing the data was the state’s legal obligation, not theirs.

Kenosha County officials, who also cited confidentiality concerns, produced their data after they were informed that a dozen other counties had already done so. An attorney for the county wrote in February, “We agree that there is public benefit in providing the data you are seeking for your report.”

Most of the county officials who were contacted had no idea how to technically export their data. Like state authorities, some argued it couldn’t be done. But one La Crosse County technician figured out the process using the state’s records system and shared her method, which the news network passed along to other counties.

The Department of Children and Families validated the La Crosse County worker’s method, though it was initially skeptical.

“As we have said before, we do not have a mechanism to do such a query without incurring considerable cost and expending significant personnel resources,” Scialfa wrote in a February email. “Please let us know who has been able to respond to your request, so that we may speak to them to see if we are missing a way to provide this information to you that we have not identified.”

The data revealed a growing number of drug-related separations in nearly all of the 16 counties, buttressing anecdotal concerns that drug abuse is splitting more families across the state. Interviews with county officials about the data also found widespread concern that current record-keeping practices are downplaying drug-related separations.

A spokeswoman for the Department of Children and Families said Wednesday that the agency “believes strongly in the transparency of government and has gone to great lengths” to make information publicly available about child protective services. She also commended the news organization’s work.

“Thank you for helping to shine a light on the tremendous threat to our families that Wisconsin, and the rest of the nation, is seeing because of the explosion of opioid dependency,” Gina Paige wrote in an email.

To read our full report, click here. Got an idea for our next investigation? Send an email to tips@gannettwisconsin.com or call our Investigations Hotline: 920-455-5025.

Keegan Kyle is an investigative reporter for USA TODAY NETWORK-Wisconsin. He can be reached at kkyle@gannett.com. Follow him on Twitter @keegankyle.

Sens. Kamala Harris and Rand Paul propose discouraging money bail for pretrial defendants

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WASHINGTON — Pretrial detention in jails across America costs taxpayers $38 million a day, according to a bill introduced Thursday by Sens. Kamala Harris and Rand Paul that proposes to give states and Indian tribes grants to encourage courts to replace the longstanding use of money bail.

The Pretrial Integrity and Safety Act would give local jurisdictions grants to transitions out of the system of bail bonding used to assure that defendants make court appearances. Harris, a California Democrat, and Paul, a libertarian-leaning Republican from Kentucky, maintain people should not be held in jail simply because they can’t pay for pretrial release.

“In our country, whether you stay in jail or not is wholly determined by whether you’re wealthy or not — and that’s wrong,” said Harris, a career prosecutor and former California attorney general.

“By giving states greater freedom to undertake reforms specific to their needs, our legislation will help strengthen protections for minority and low-income defendants, reduce waste and move our bail system toward more effective methods, such as individualized, risk-based assessments,” Paul said.

The bipartisan bill would make it the sense of Congress that unnecessary detention may be counterproductive, noting studies indicate that those detained for more than 24 hours and then released are less likely to reappear in court than those held less than 24 hours.

Citing a 1983 U.S. Supreme Court case, the bill notes the court found unconstitutional, and prohibited, “punishing a person for his poverty,” which Harris and Paul maintain can occurs with money bail. The consequences of pretrial detention, the bill says, can be devastating and include loss of employment and threatened child custody.

In addition, defendants sitting in jail are hindered in gathering evidence and contacting witnesses in the preparation of a legal defense. An inability to make bail “may result in innocent individuals pleading guilty to low-level crimes so they can be released,” the bill says.

The Harris-Paul bill would amend a 1968 crime control law to encourage “evidence-based” approaches to assuring defendants return to court. It would provide $10 million to no more than six state or tribal court systems per year for analysis, training and technical assistance to assess “risk of flight risk” with a presumption favoring release in most cases.

Those receiving the Justice Department grants would seek to have 95 percent of defendants return to court as scheduled with release rates of 85 percent of those awaiting trial. Hearings to make the risk assessment would occur within three days of arrest or booking. Judges would be encouraged to find non-financial conditions for release to assure returns to court.

Beth Chapman, chairman of the board of directors of the Professional Bail Agents of the United States and the co-star of A & E Television’s “Dog The Bounty Hunter,” did not immediately respond to a request for comment on the legislation.

A 2015 Public Policy Institute of California study showed that California’s median bail amount, at $50,000, is five times higher than the national average and noted pretrial release generally declines as bail amounts increase. In late 2014, 62 percent of the California jail population were awaiting trial or sentencing.

The same study found California had a higher rate of failures to appear than the rest of the country.

Although distant ideologically on many issues, Harris and Paul have been quietly working together on the effort over the past few months with occasional shout-outs. Harris mentioned in a speech in may that Paul has been advocating a “better approach” to handling drug addiction while Paul mentioned Harris in a Twitter blast calling for reform of the criminal justice system days later.

Harris is expected to tout the proposal when she speaks at the NAACP convention Monday in Baltimore.

Hobart man sentenced to four years in heroin death case

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GREEN BAY – A Hobart man will spend four years in prison for providing the heroin that contributed to a woman’s death two years ago.

Matthew L. Belekevich, 32, was sentenced for delivery of heroin, a charge reduced from an original charge of first-degree reckless homicide. The charge was reduced when prosecutors learned that Destinie Saldana, 21, died July 15, 2015, of polysubstance overdose. Tests revealed other illegal drugs in her system that she apparently had taken independently of the heroin Belekevich gave her, but which might have been sufficient to kill her even without that heroin, prosecutors said.

Brown County Circuit Judge Kendall Kelley ordered that Belekevich spend five years on extended supervision following his prison term.

Kelley said he gave consideration to the fact that Belekevich turned evidence on the man who had supplied him with the heroin and even agreed to make a controlled buy for drug investigators, further implicating the man. Deante Chambers, 33, of Green Bay is serving eight years in prison for those two crimes.

Belekevich called 911 after finding Saldana dead in his bedroom, a complaint says.  The two injected heroin together, and later Belekevich injected her with Narcan, an antidote to a heroin overdose.  She later asked him to inject her with another dose of heroin, the complaint says.

Belekevich, meanwhile, faces two new felonies and a misdemeanor. He is accused in Brown County Circuit Court of sexually groping a woman, battering her and being drunk, all in violation of terms of his bond in the heroin case.

The complaint says he forced himself on the woman while visiting her and her family at her De Pere home on June 22. He attacked her in her driveway at 4:30 p.m., and when she pushed him a way, he told her, “Do you know who I am? I’m Matt (expletive) Belekevich,” the complaint says.

He could face 56 years in prison for second-degree sexual assault, battery and bail jumping, all charged with a repeat offender enhancement. He is jailed on a $20,000 cash bond in the case and is awaiting an Aug. 4 plea date.

Stingl: After son’s heroin death, a banker seeks healing in yogurt shop and addiction awareness

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For a year after his son died, Alex Hoffmann wore the Buddhist prayer beads that were on the 22-year-old’s wrist when heroin took him.

When the string of orange beads became too fragile, Alex placed them in a cloth bag that he carries in his pocket.

“He’s with me every day,” Alex said.

Shay Hoffmann could not have imagined the profound changes his addiction and death would have on his father’s life.

Alex will tell you he lost nearly everything. His 30-year banking career. His family’s east side Milwaukee home. His financial security in a bankruptcy. His health. His marriage. Even his freedom after he was busted four times for driving after trying to drown the pain with alcohol.

“I folded. I admit it. It was too much to carry. I’m the dad and I’m supposed to figure it all out and save my son. And I didn’t.”

Alex hit bottom, and then he rebounded with tireless passion to heal his soul, to share the message of addiction with anyone who would listen, and to honor his son’s memory by pushing for effective drug laws.

Perhaps most surprising of all, he began running a frozen yogurt shop and giving away the profits to deserving groups and causes.

“The issue was you either crawl into a hole, or you do something about it,” said the 64-year-old who lives in Menomonee Falls.

Shay, who was born Christopher James Shabart Hoffmann, was a “charismatic, witty, big-hearted soul” who loved sports, snowboarding, art and music, his death notice says.

But during his three years at Marquette University High School, he began using narcotic pain pills and heroin and spiraled downward, despite attempts at rehab. He entered Auburn University, but lasted less than a year there after showing signs of schizophrenia.

His parents, brother, sister, everyone tried to help him get and stay clean. It wasn’t enough. Shay died at a local hospital July 1, 2013, three days after he collapsed at his mother’s home on the east side.

“Intellectually, I know I did what I could. In my heart, I’ll feel guilty the rest of my life. It’s just a fact. You can’t really change it,” Alex said.

He was in jail at the time of Shay’s death and getting out during the day to work as a cook at a restaurant in Hubertus. A customer he met there, business executive Paul Armitage, offered to help Alex rebound. Armitage put up the money and in October 2013 the two men opened Yo Cool Frozen Yogurt at N78 W14579 Appleton Ave., Menomonee Falls.

Their desire was to make a positive difference, and the shop has hosted many events for schools, sports teams, churches, community groups and causes, passing along the profits to them. For Alex, the new job was a radical departure from his years as president of Universal Savings Bank in Milwaukee and head of the Wisconsin Mortgage Bankers Association.

He didn’t stop there. He contacted state Rep. John Nygren (R-Marinette), whose daughter, Cassie, also has struggled with drug addiction, and they became allies in pushing for legislation to save lives, allow for wider access to Narcan to counteract opiates, and offer limited criminal immunity for people who overdose and those who are with them.

“He doesn’t accept the political roadblocks that come along,” Nygren said. “He’s been a big driving force behind a lot of what we’ve done.”

Close friend Jim Morrison witnessed Alex’s dissolution and how he was able to quit drinking and pull up. “He’s an amazing guy to be taking the road he’s on now. It’s no longer the low road,” he said.

Michael Rogowski, a lawyer who has helped Alex, said, “Somehow in the face of all the pain and suffering Alex has had to endure, he has stepped up and stepped out as a truly inspirational individual.”

In 2014, Alex shared his story with the Assembly Criminal Justice Committee. He has met with Gov. Scott Walker, legislators and others. He has spoken at the Milwaukee Heroin Summit and at rehab centers and with other families struggling to understand addiction.

Now, he’s pushing for a state addiction czar, someone who would coordinate the complicated interplay between families, lawmakers, law enforcement, health care providers and others. He offered to do the job for $1 a year.

“There’s no question it’s helping me,” Alex said of his efforts to protect others from the devastation his family experienced. “As long as every day I can move forward and do something to help other people.”

Fight against opioid abuse in Wisconsin continues | Column

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Six months ago, we asked for an escalation in our efforts in the fight against opioid abuse in Wisconsin. Hospitals, schools and community groups have joined hands with state and local governments in response to that call, and we’ve seen significant progress implementing the recommendations we put forth.

We applaud Gov. Scott Walker for signing three executive orders, one of which called a special session of the state legislature to act expeditiously on the legislation we recommended. We appreciate the committee chairs and members who reviewed the bills and all our colleagues who supported them on the floor. We’re proud of the wide bipartisan consensus around these common-sense steps.

Six months later, things are on a good track. Governor Walker traveled to Green Bay, Wausau and La Crosse Monday to sign the special session bills into law. New moneys are going out the door to support programs on the ground, and state agencies are implementing new policies to address this issue across government.

Though we’re pleased with the progress we’ve made, our efforts continue. Along with our task force colleagues, we are already hard at work assembling ideas and talking to experts on next steps. Last week, for instance, nationally recognized policy analysts from the Pew Charitable Trusts testified before our task force with ideas for policy solutions with the goal of helping those who need addiction services. Though we are absolutely confident that our past work is making a real difference, headlines in hometown newspapers across our state remind us every day that more must be done.

As we look to our next set of recommendations in tackling this complex issue, we want to focus on two areas in particular. First is our Medicaid. We know that enrollees on Medicaid are disproportionately impacted by the opioid and heroin epidemic. We also know that different states take varying approaches to a host of other opioid-related questions within their Medicaid programs, and that Medicaid’s policies can act as an incentive to expand the number of practitioners offering addiction-related services. Finally, we recognize a moment of opportunity as our federal partners at the U.S. Department of Health & Human Services have invited states to submit creative ideas to combat this crisis. We want Wisconsin to be one of the first states out of the box with an innovative, comprehensive proposal, and we want Wisconsin Medicaid to serve as a model for the optimal arrangement of benefits and treatment options.

We also want to focus on preventing addictions in the first place. We invest a lot of money in treatment, and we should, because lots of our citizens have a medical issue that requires a treatment solution. But we also want to move beyond time-worn answers like “DARE” or “Just Say No” to reach deeper questions around propensity to addiction, self-reliance and self-medication, and creating cultures of accountability.  We want to have an open, honest conversation about the role that schools, colleges, faith communities, families, coaches, neighbors — all of us really — can play in developing resilient citizens.

We don’t expect prevention to ever be perfect; we recognize that we all have moments of weakness where we make bad choices. But we want to at least start asking what levers of policy we can pull to do more on the front end so we can spend less time and money on the back end in emergency rooms and jail cells.

We anticipate coming back to the citizens of Wisconsin at the end of 2017 with additional ideas on these issues and the larger project of ending opioid abuse. Until then, we invite you to partner with us — you can start by learning more and sharing your ideas through our website, www.Hope.WI.gov.

‘Abandoned’ motor home filled with drugs in rural Fond du Lac County

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FOND DU LAC – Pot, psychedelic mushrooms and pills were discovered in a motor home reported as “abandoned” at a gas station in rural Fond du Lac County.

A 26-year-old Fond du Lac man is in custody, charged with numerous drug-related offenses, and the Lake Winnebago Area Metropolitan Enforcement Group is investigating the extent of drug-related activities that have taken place at this location.

Fond du Lac County Sheriff’s deputies were called to investigate the 40-foot-long motor home that was parked in the rear parking area at Eden Corner Express convenience store in the village of Eden.

Capt. Ryan Waldschmidt said it appeared the motor home had been there for a while, and was easily hidden among the semitrailers that use the back lot to park overnight.

The man, who was inside the motor home, told deputies he was the owner, was taken into custody on an outstanding warrant, according to a press release from the Sheriff’s Office.

A search warrant of the vehicle by the MEG unit turned up significant drug activity, including marijuana, psilocybin mushrooms, forms of manufactured THC and pills. Drug paraphernalia and cash were also seized.

A woman was also found inside the home.

Agnesian HealthCare offers easy access to health care providers’ notes

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FOND DU LAC – Agnesian HealthCare patients who utilize Agnesian eHealth are benefiting from easier access to the notes their providers write in their medical records.

That initiative was recognized as part of a keynote address to other health care providers at the Healthcare Information and Management Systems Society annual conference in Orlando.

Agnesian eHealth allows patients to be a more proactive member of their care team. With Agnesian eHealth, patients can view their personal health information and laboratory results, request appointments and request a medication refill from their health care provider.

The most recent addition complements efforts by the Wisconsin Collaborative for Healthcare Quality, or WCHQ, who recently announced that one million more Wisconsin patients will soon have ready access to their providers’ notes.

This work represents the local implementation of OpenNotes, a national movement advocating for enhanced communication between patients and providers through shared clinicians’ notes and fully transparent medical records.

“Patients have instant access to not only provider notes, but laboratory results, medications, radiology studies and their health concern list,” according to Ann Cappellari, M.D., Agnesian HealthCare chief medical information officer. “They can renew medications online, request appointments and message their provider. It engages them in their own care, and it aligns with meeting the needs of a mobile and device-connected population.”

Agnesian HealthCare has been offering OpenNotes since July 2015, says Nancy Birschbach, Agnesian HealthCare vice president and chief information officer. In fact, Agnesian HealthCare was one of the initial health care systems in Wisconsin that launched this capability.

“All of our providers through the Fond du Lac Regional Clinic offer this easy access to important medical records,” Birschbach said. “We know that our patients appreciate the convenient this gives to them, and provides an effective way to track any medical concerns and specific directions given by their providers.”

Cappellari concurs. “It is a great resource to access provider plans after a visit, to recall details of diagnoses and medical decisions. They can share health information with outside providers for the best possible care with the most recent information.”

Jill Immerfall, 39, of Fond du Lac, values being able to review notes from her visits with multiple providers at Agnesian HealthCare.

“At some of my visits, we cover a lot of information,” Immerfall says. “It’s helpful to go back and review what was said during the visit and gives me a good reminder on the next steps I need to take for future visits. It’s easy to forget what you hear at the time, especially when you are trying to stay focused and listen to what your provider is saying.”

Agnesian HealthCare had individuals like Immerfall in mind when moving forward and supporting OpenNotes.

“Agnesian Healthcare is working to transform care by making health information as easily accessible as possible so patients are better informed,” says Cappellari. “The more information patients have on their own health, the more engaged they are in medical decisions and their own plan of care.”

Coroner confirms Chester Bennington died by hanging; Linkin Park cancels tour

AP OBIT CHESTER BENNINGTON A ENT USA NJ

Linkin Park frontman Chester Bennington died by hanging, the Los Angeles County coroner confirmed Friday.

Linkin Park’s One More Light tour, which was to begin next week, was canceled, according to a Friday statement from concert promoter Live Nation.

“We are incredibly saddened to hear about the passing of Chester Bennington. The Linkin Park One More Light North American Tour, including Blinkin Park dates, has been canceled and refunds are available at point of purchase. Our thoughts go out to all those affected.”

Brian Elias, chief of operations for the office of the medical examiner-coroner, said the 41-year-old rocker hanged himself from a bedroom door in his home near Los Angeles on Thursday.

Bennington was found dead at his home in Palos Verdes Estates in south Los Angeles County. Elias said the body was discovered shortly before 9 a.m. PT by a housekeeper who called 911. The Fire Department pronounced him dead at the scene.

The coroner’s office said Thursday Bennington’s death was being investigated as a possible suicide but few details were disclosed. The case is not yet officially closed, Elias said, but it is still being investigated as a suicide by hanging.

An autopsy has been scheduled for Friday, he said.

A half-empty bottle of alcohol was found in the room but there were no signs of illegal drugs or paraphernalia present, Elias added.

Bennington, an Arizona native known for his raw, raging vocals, endured an on-and-off battle with addiction to drugs and alcohol, a subject he discussed candidly in many interviews and mined with his music in hits like 2000’s Crawling: “Crawling in my skin / These wounds they will not heal / Fear is how I fall / Confusing what is real.”

Friends and fans reacted with shock and sorrow on social media. Among them: His bandmate, Mike Shinoda, who tweeted: “Shocked and heartbroken, but it’s true.”

Another generation of music fans remembered a frontman who represented the seminal rock-and-rap sound of their youth.

Bennington was one of two lead vocalists for Linkin Park, the nü-metal band that became one of the most commercially successful acts of the 2000s. They won countless awards, including Grammys, and their hits include In the End‘What I’ve Done and Numb.

Blackhawks looking to old, new faces in quest for Cup

Chicago Blackhawks' Brandon Saad is introduced to the fans during the NHL hockey team's convention Friday, July 21, 2017, in Chicago. (AP Photo/G-Jun Yam)

CHICAGO (AP) — Following a second straight first-round playoff flop last April, the Chicago Blackhawks responded with roster changes that cut all the way to their core of high-priced stars.

Chicago reacquired fan favorites Patrick Sharp and Brandon Saad in the process. Both may end up back in familiar spots, even if general manager Stan Bowman says it’s time for the Blackhawks to come up with a fresh recipe for Stanley Cup success.

“We’re trying to create some new chemistry and some different looks next year,” Bowman said Friday at the Blackhawks’ fan convention. “We’re trying not to look backwards. We’re trying to look forward and that goes for all of our players who are trying to get better.”

The Blackhawks topped the Western Conference with 109 points last season and were expected to challenge for their fourth Cup since 2010. But they were swept in the first round by Nashville — after being ousted in their opening series by St. Louis the year before.

Shot-blocking defenseman Niklas Hjalmarsson, a key member of Chicago’s 2010, 2013 and 2015 Stanley Cup teams, was shipped to Arizona in a deal that netted 24-year-old Connor Murphy. Artemi Panarin — and his 31 goals and 43 assists — went to Columbus in a multi-player trade to reacquire a more complete, physical forward in Saad, who contributed to Chicago’s last two championships.

Sharp, who spent the past two seasons in Dallas, had hip surgery in March and signed as a free agent. The 35-year-old played 10 seasons in Chicago, where he scored 33 or more goals four times.

Top prospect Alex DeBrincat, the Ontario Hockey League player of the year, is knocking on the door. And Blackhawks are banking on improvement from last year’s rookie forwards.

Coach Joel Quenneville all but promised to reunite Saad on a line with captain Jonathan Toews. The two clicked together during Chicago’s 2013 and 2015 Cup runs, and this time, Quenneville envisions Richard Panik joining the unit.

“I think that Jonny’s line is key for our team’s success,” Quenneville said. “Those three potentially being on a line really is good to see — some size, some strength, puck possession.”

The 24-year-old Saad is on board.

“That’s, I think, the plan and you never know with Q,” Saad said. “It’s always switched up to his liking. But me and Jonny had some success in the past, and I definitely feel excited to hopefully be reunited with him.”

Another line could include puck magician Patrick Kane on right wing and Artem Anisimov at center. Quenneville said it’s a “possibility” that Sharp, who has resumed skating, could join on the left side.

“Whether he plays up there or with Jonny is an option as well,” Quenneville added. “He gives us some versatility.”

Sharp said he’s recovered fully from surgery.

“I had my best years playing for Coach Q, and I know wherever he puts me in the lineup is probably going to be best for me and for the team, as well,” Sharp said.

Duncan Keith and Brent Seabrook will again anchor Chicago’s defense. Beyond that, the Blackhawks will be younger with Murphy grabbing ample ice time and prospects like 21-year-old Gustav Forsling getting chances.

“On the back end we probably are going to have some new pairs and some new looks as well,” said Quenneville, a former defenseman who hasn’t always been patient as a coach with young defenders. “So I think it will be fun trying to go through that process.”

The Blackhawks lost one key player with no compensation.

Marian Hossa, who had 26 goals last season, will miss 2017-18 because of side effects from medication to treat a skin disorder and may not play again. The 38-year-old has 525 career goals and 1134 points.

“It’s heartbreaking what he has to go through when you know it’s too soon,” Toews said. “He’s got a ton left on the table.”

Many of key players on Trump health care reform team are Hoosiers

SEEMA VERMA

WASHINGTON — Several Hoosiers in key positions in the Trump administration, led by Vice President Mike Pence, are negotiating the future of federal health policy despite the state’s mixed reputation on health care.

Indiana spends less on public health funding than any other except Nevada, a handicap when Indiana was home to the nation’s first HIV outbreak linked to the injection of oral painkillers in 2015.

In addition, the state for years has ranked among the least healthy. Hoosiers smoke more, are less active and die sooner than most Americans.

Before Pence became vice president, however, he was among the minority of Republican governors who expanded their state’s Medicaid program — a move which gave hundreds of thousands of Hoosiers access to health care and helped the state respond to the HIV outbreak.

Pence has been a leader of the Trump administration’s so far unsuccessful efforts to repeal the Affordable Care Act Obamacare, including phasing out its Medicaid expansion — a program Pence’s successor is using to fight the opioid addiction epidemic.Another former Pence health policy aide now helps Health and Human Services Secretary Tom Price — a good friend of Pence’s — work with Congress on the agency’s legislative agenda.

Long-time Pence aide Matt Lloyd, the top HHS spokesman, is the “sherpa” to help guide the Trump administration’s surgeon general nominee through Congress.

President Donald Trump’s pick? Indiana’s state health commissioner, Dr. Jerome Adams, who was appointed to his position by Pence.

“It’s certainly significant,” Eliot Fishman, the CMS official during the Obama administration who worked with Indiana on granting approval for its alternative Medicaid program, said of the concentration of Hoosiers in health policy positions. “But, for myself, I was hopeful that having people who had successfully negotiated, and then implemented, an innovative Medicaid expansion in Indiana would have led to more support for Medicaid expansion nationally. I have not seen evidence of that yet.”

Tom Miller, a health policy expert at the right-leaning American Enterprise Institute, said it’s understandable that so many Pence people ended up in key health care positions.

“It didn’t light up President Trump as the thing he was most deeply invested in, and had a range of experience in,” Miller said. “Mike has some experience, knowledge and engagement in this area of policy — more so than most other folks close the issue in the White House. So it’s not surprising that he is taking the lead on this.”

Indiana is home to some significant players in the health care industry. Anthem, one of the largest insurance companies, is headquartered in Indianapolis, as is drug maker Eli Lilly and Co.

Warsaw, Ind., is known as the “Orthopedic Capital of the World” because of the concentration of medical device makers.

And health savings accounts, the tool Republicans have championed as a way to make consumers more invested in their health care decisions, were pioneered by an Indiana insurance entrepreneur as an alternative to traditional health insurance. (The alternative Medicaid program Verma helped Pence create for Indiana’s Medicaid expansion mimics aspects of health savings accounts.)

Yet, despite Indiana’s leadership in sectors of the health care industry, the state ranks near the bottom on many health measures.

On the most recent overall ranking by the United Health Foundation, Indiana comes in at 39th healthiest. That scale takes into account behaviors, environmental health, policies, clinical care and outcomes.

Not surprisingly, the category that stands out the most to Paul Halverson, dean of Indiana University’s Richard M. Fairbanks School of Public Health, is public health funding. Indiana’ ranks 49th on spending per capita on preventive and education programs that improve health.

“We just have not prioritized public health funding in Indiana in a number of years,” Halverson said. That’s despite the fact, he said, that studies show properly funded public health systems can reduce medical care expenditures and increase life expectancy.

The HIV outbreak in Southern Indiana put a spotlight on the weaknesses in the state’s health infrastructure.

Still, Halverson gives a lot of credit to Adams — the state health commissioner poised to become the nation’s top doctor — for how he worked with Pence to respond to the outbreak. The response included allowing needle exchanges despite Pence’s initial reservations.

Pence’s successor, Indiana Gov. Eric Holcomb, has made reducing the number of opioid deaths one of his top goals as governor.

But Holcomb’s strategy to fight the opioid epidemic relies heavily on Medicaid, the jointly funded state and federal program which Pence is pushing hard to curtail.

Pence’s support, as governor, for expanding Medicaid in Indiana was a departure from his congressional record. He had voted against adding a prescription drug benefit to Medicare and against expanding the health care program for lower-income children whose families make too much to qualify them for Medicaid.

Still, Pence never completely closed to the door to finding a way to accept the federal funding made available through the Affordable Care Act to expand Medicaid eligibility.

“Clearly, Governor Pence had policy concerns about expanding Medicaid,” said Brian Tabor, executive vice president at the Indiana Hospital Association, which pushed hard for the expansion. “But he never said `no.’”

The alternative Medicaid program Pence and Verma got the Obama administration to sign off on was one of Pence’s top achievements as governor.

“Despite being a conservative state, they — generally speaking — overcame their conservative credentials to support policies that expanded coverage for people, even though they did it with a conservative flavor to it,” said Andy Slavitt, who headed the Centers for Medicare and Medicaid Services under former President Barack Obama.

Whether Pence’s program, which requires participants to make monthly contributions if they want more comprehensive coverage, works better than traditional Medicaid is still being evaluated.

But Verma knows how crucial the ACA funding was to making the expansion possible, said Fishman.

“There was just no way from a budgetary perspective that Indiana could have expanded coverage … at the regular (federal reimbursement rate),” Fishman said.

That’s not something Pence and Verma talk about as they’ve tried to sell lawmakers and governors on replacing Obamacare with legislation that would phase out the ACA’s extra federal funding for Medicaid while also reducing the federal government’s financial support for regular Medicaid.

Governors who heard their pitch at this month’s National Governors Association summer meeting were skeptical.

“He was selling ice beverages in the wintertime,” Miller, the think tank expert, said of Pence. “(Governors) wanted to know how they were keeping the money they already had, and they were trying to tell them they’d be better off, even though it seemed like they were getting less. That’s hard to pull off.”

Pence — who has been traveling the country and holding roundtable discussions at the White House to highlight the “Obamacare disaster” as well as courting lawmakers by phone and in private dinners at his residence — has been more active than Trump in trying to pass repeal-and-replace legislation. He played a key role in getting changes to the House bill so it could pass that chamber in May. But the Senate’s version is stalled.

If Senate Majority Leader Mitch McConnell, R-Ky., can’t round up enough GOP votes next week to bring any health care bill to the floor, legislation may be shelved for the foreseeable future. That will shift the focus to the changes the administration is able to make through agency action.

Pence and Verma have told governors the Trump administration will be more permissive — and act faster — on state requests to try new approaches.

“It took our state more than two years for the federal government to approve our waiver,” Pence told governors at the summer meeting. “And even then, they frankly, rejected an awful lot of what we were trying to do.”

Fishman, who called the negotiations he conducted with Verma on Indiana’s request intense but ultimately successful, said that experience likely contributed to Verma’s commitment to letting states test their own approaches. But he suspects the administration will push the limits on the federal rules they’re allowed to waive under the law.

“It’s likely that there will be litigation,” he predicted.

Slavitt, who like Fishman has been a vocal opponent of the repeal and replace efforts, said it would be a mistake to take too much of an ideological approach to policy changes.

“If people come to the job and do what they did in Indiana, which is focus pragmatically on how to expand coverage,” he said, “that would be a good thing.”

Contact Maureen Groppe at mgroppe@gannett.com. Follow her on Twitter: @mgroppe.

Hoosiers in key federal positions to shape health care policy:

Mike Pence: As vice president, Pence has a lead role in the Trump administration’s effort to undo the Affordable Care Act. Obamacare. Pence has been more active than Trump both publicly and privately in trying to get repeal and replace legislation through Congress. As governor, Pence was among a minority of Republicans who took federal funding made available under the Affordable Care Act to expand Medicaid.

Seema Verma: The administrator of the Centers for Medicare and Medicaid Services, Verma has been helping the administration explain to lawmakers and governors the Medicaid changes proposed in legislation. She’s also encouraged states to seek permission from her office for local approaches to running Medicaid. A former Indiana-based health care consultant, Verma helped create Indiana’s alternative Medicaid program and worked with other states on unique approaches.

Brady Brookes: Brookes is Verma’s deputy chief of staff. She was legislative director for Pence when he was governor.

Brian Neale: Neale is a deputy CMS administrator, overseeing Medicaid and the health care program for low-income children whose families make too much to qualify for Medicaid. When Neale was Pence’s health care policy director in the governor’s office, he and Verma negotiated permission from the Obama administration to expand Indiana’s alternative Medicaid program.

Tyler Ann McGuffee: A former health care policy director for Pence, McGuffee works on Health and Human Services Secretary Tom Price’s legislative agenda and is a liaison between Congress and the agency.

Matt Lloyd: Spokesman for the Health and Human Services Department, Lloyd was Pence’s deputy chief of staff in the governor’s office and worked for him for years on Capitol Hill. In addition to his spokesman’s job, Lloyd is helping shepherd Trump’s surgeon general nominee through the Senate confirmation process.

Dr. Jerome Adams: Indiana’s state health commission has been tapped by Trump to be the next surgeon general. Adams was appointed to his state position by Pence.