Indiana – It was the best of times, it was the worst of times – Healthcare Blog

Author: Mike Magee

'Indians return to Bloomington to receive a hero's welcome' ESPN headlines last week screamed that Indiana University is at the top of the national college football game. It's been a while since sports lifted the mood in the state.

In his classic review of the famous film “The Hoosiers,” Roger Ebert wrote, “This is a movie about a small high school in Indiana that sent a team all the way to the state basketball finals in an era when schools of all sizes competed in the same tournament and David could slay Goliath. That's still the case in Indiana.”

I was reminded of those last words last month, when this Midwestern state with a population of about 7 million (17th in the country) surpassed its political clout and made headlines like this on December 11, 2025. hills – “Indiana Senate rejects new House map, ignores Trump.”

Some facts are clear: 21 Indiana senators joined all 10 Democratic state senators in vetoing a proposed redistricting map that would have secured an additional two House seats for Republicans in the 2026 midterm elections. But most political pundits misunderstood why they did so and ignored important economic reports from 10 months ago that informed their actions. More on that later.

First, a little history. A century ago, Eli Lilly and Company, the grandson of the founder of famed pharmaceutical giant Eli Lilly, struck a deal with the University of Toronto to become its exclusive supplier of the life-saving drug insulin. Their headquarters is located in Indianapolis, Indiana, which is ideally located as the state's three main economic pillars are manufacturing, agriculture, and health sciences.

Ensuring an adequate supply of insulin represents a historic scientific and logistical challenge. Eli Jr.'s focus on line manufacturing helped. Raw material requirements required the design of a refrigerated rail support system at the Lilly manufacturing facility. This is necessary because purifying 8 ounces of insulin requires two and a half tons of beef or pork pancreas, which can be readily obtained from state farms. Sourcing raw materials locally is not a problem. At that time, 86% of the state's land was controlled by 195,786 farming families engaged in agriculture, including livestock management and slaughterhouses.

A century later, the country still relies heavily on its three pillars – manufacturing, agriculture and health sciences. That was the message delivered in the first economic forecast update, released on April 15, 2025, in Muncie, Indiana, and it had huge political implications. Muncie is home to Ball State University and its respected Center for Business and Economic Research, led by Dr. Michael J. Hicks. For more than 50 years, CBER has published “data-rich, nonpartisan research relevant to communities and businesses across Indiana.” Their reputation is built on one word – trust.

On January 16, 2025, CBER released its highly anticipated 2025 state economic forecasts. Local politicians and business people are encouraged by forecasts of 2.5 percent GDP growth and 37,000 new jobs, with Dr. Hicks saying, “This is the strongest forecast I've offered since I've been here at Ball State.” But there's a warning in the fine print: “The direction of domestic fiscal policy, particularly tariffs, adds unusually high uncertainty to this forecast. “

On April 15, 2025, minutes after CBER released “CBER Forecast Update: Indiana 2025,” bells began to ring south of Muncie, Indianapolis, the capital. Hicks said in his opening remarks that Trump's economic policy actions “warrant a significant revision to the state's 2025 forecast.” They are now able to calculate that “import and production taxes on Indiana manufacturing companies have increased eightfold, bringing the trade-weighted average tariff to 22.3%.”

To illustrate how devastating this was to their state, three points were highlighted:

1. The total amount of tariffs imposed by Trump is equal to the state’s projected general fund revenue for the entire year.
2. The program's tax rate matched the Smoot-Hawley Act tariffs that triggered the Great Depression in 1930.
3. Uncertainty and risks to the state's economy have led to a 26 per cent drop in job adverts in three months.

Compared with the previous analysis, GDP growth fell by 4.5%, from +2.3% to -2.0%, and employment fell by 92,000 from +37,000 to -55,000, including a decrease of 19,000 manufacturing jobs. The report said the unemployment rate will rise to just under 6% by the end of this year.

Indiana is vulnerable to the large negative economic impact of a second Trump term, according to state economists. Trump tariffs and A big, beautiful banknote The Republicans were forced to accept and push for passage that would destabilize their three-way economy by:

1. Manufacturing: In addition to tariff-related cost increases for automobiles, machinery and construction parts, supply chain disruptions and inventory management disruptions will be difficult to reverse. Delays and price increases could lead to retaliatory tariffs and reduced demand for Indiana products being diverted to overseas customers.
2. Agriculture: Export markets for Indiana’s three largest agricultural products — corn, soybeans and pork — have been severely impacted by the state’s farm communities. ICE immigration policies have a negative impact on labor supply, harming productivity and competitiveness.
3. Health Care: Indiana residents are large consumers of ACA benefits, which are provided in the form of Medicaid expansion and federal ACA marketplace policies, with subsidies up to 400% of the federal poverty rate. The loss of these subsidies in January 2026 is expected to result in an average ACA insurance rate increase of 31.14% for 300,000 Hoosiers

The summary of the warning is not subtle: “Indiana is now entering a recession; This will remain the case until some time after tariffs are significantly reduced and freer trading conditions are reestablished. . . This is a policy-induced downturn. “

Over the next seven months, the toxic effects of the bad financial news spread, and Republican leaders in statehouses grew increasingly dissatisfied that their Republican congressional leaders were in lockstep with the president they had elected 13 months earlier by a whopping 20 percent margin.

To add insult to injury, President Trump personally asked them to pass an unpopular redistricting plan in order to gain two additional House seats in the 2026 elections. At 8:27 pm the night before the vote on December 10, he threatened the state’s Republican lawmakers on Truth Social, saying: “I am convinced that anyone who votes against redistricting and the success of the Republican Party in Washington will have a Make America Great Again primary in the spring.”

What went unnoticed was the fact that Vice President Mike Pence came to the rescue on January 6, 2020, as presiding officer of a joint session of Congress to certify the legitimate results of the 2020 election. His actual remarks included a rebuke directed at his current tormentors: “I am proud of my role…There are few ideas more un-American than the idea that anyone can choose to be president of the United States…The presidency belongs to the American people, and the American people alone.”

The Dec. 11, 2025, statehouse vote struck down redistricting and was defined by national news media as “a major blow to President Trump.”

Reporters from around the country rushed to try to explain, “Why take a stand now?” The next day, The Huffington Post did its best to explain why, publishing an article titled “These Indiana Republicans Voted to Smash Trump’s Redistricting Plan.” In true Hoosier fashion, Sen. Sue Glick of LaGrange, Indiana, made her point: “Hoosiers are a tough bunch of people and they don't like to be threatened. They don't like to be intimidated. They don't like to be bullied in any way.”

But the real answer lies closer to Muncie, the capital of Indianapolis and home to Ball State University's CBER. As director Michael Hick clearly predicted a few months ago, “This is a policy-induced recession.”

Mike Magee, MD, is a medical historian and the author of Code Blue: Inside the American Medical-Industrial Complex. (Grove/2020) and regular contributor to THCB