It’s working, even in an unlikely place: Indiana, which has had some of the nation’s highest hospital prices. Over the past few years, Indiana lawmakers have passed bills pushed by Sachdev that target complex and sometimes wonky health policy issues.
Sachdev, who is 55, trained as a pharmacist and for years led a coalition of Indiana businesses. In her quest to shake up the status quo, she sparked the creation of a national report on hospital pricing. She won over powerful Republican donor Al Hubbard, who has championed her proposals. She’s convened health-care experts from across the country to tackle cost transparency. In turn, all this has elevated her profile in Indiana and beyond.
Now, this disruptor has ascended to a position of power in the Hoosier State. Indiana’s new Republican governor, Mike Braun, appointed her to a newly created Cabinet position overseeing the state’s health-care agencies.
Republican leaders in Indiana have been receptive to Sachdev’s work, persuaded by her argument that the free market approach of limited government intervention, long favored by the GOP, doesn’t work with health care.
“I believe in a free market, too,” she said.
But health care isn’t like a grocery store where shoppers have lots of options in the cereal aisle and can see the prices. Too often, Indiana patients are left with few choices and no price transparency, Sachdev said. That messaging has resonated with Indiana Republicans, she said, because they see it in their own communities.
A decade ago, when she began representing frustrated employers as chief executive of the Employers’ Forum of Indiana, she asked the businesses within that coalition to identify their biggest pain point: “They unanimously said health-care affordability.”
Driven by Data
Sachdev had spent years training as a pharmacist, pursuing a career in health care like her father. He was a researcher at the University of Oklahoma who made advances in decoding cystic fibrosis, a life-threatening genetic disorder that damages the lungs.
In her own career, Sachdev said, she has always sought answers to seemingly simple questions, driven by data and her belief that sound policy stems from rigorous analysis of the available evidence. So to examine the employers’ concerns, she sought to find out how health-care prices in Indiana compared with those in other states. No such data existed at the time.
She cold-called Chapin White, then an economist at the Rand Corp. research organization, and persuaded him to help her find the answer. After some initial studies of Indiana, Rand published a study in 2019 that analyzed the prices paid by private health plans to more than 1,500 hospitals across the nation.
The results shocked her: Indiana landed at the top of the list, with the highest hospital prices among the 25 states initially studied. Sachdev was incredulous that her adopted state had earned such a dubious distinction. “We’re not New York City,” she said.
The results emboldened her — and state lawmakers — to take action. “When we’re highlighted like that, it certainly requires our attention,” said Chris Garten, the majority floor leader in the Indiana Senate and a former chair of the General Assembly’s oversight task force on health-care costs.
National Influence
The push for transparency also gained momentum nationally, leading President Trump to issue an executive order in his first term that required hospitals to publicly disclose prices.
“Gloria was the catalyst for getting this started,” said Brown University economist Christopher Whaley, one of the other authors of the price transparency report while at Rand.
Consolidation has fueled higher prices in medical care. But Indiana is an outlier in how it chose to respond to consolidation, at least among red states, said Katie Gudiksen, executive editor of The Source on Healthcare Price and Competition, an online resource from the University of California Law-San Francisco.
Over the past few years, Indiana legislators have enacted laws to combat consolidation, banning large hospital systems from tacking on extra fees, restricting employers from imposing noncompete contracts on primary care physicians, and requiring health-care companies to report pending mergers to the state’s attorney general.
Sachdev called the move to ban extra fees in some hospitals a major victory. Across the U.S., hospitals may add an extra charge to a bill, known as a facility fee, even when the visit happens outside the hospital at an affiliated doctor’s office. Indiana’s law not only lowers prices, she said, but also removes an incentive for hospitals to buy up physician practices for the purpose of tacking on a facility fee.
“All of our efforts are really in this space of increasing competition,” she said.
Coping With COPA
Last spring, Sachdev drew national medical pricing experts to Indianapolis for a conference on health-care transparency. Celebrity entrepreneur Mark Cuban, a critic of high prices in the industry, was a keynote speaker.
At the conference, the latest installment of the Rand report was unveiled. Indiana had fallen from the top spot to the state with the ninth-highest prices.
Last fall, however, a hospital merger threatened to undo some of Sachdev’s wins in Indiana. Rival hospitals in Terre Haute were seeking to merge. The deal would have left the city and those in the surrounding rural areas with a hospital monopoly, and such consolidations elsewhere have been shown to raise medical prices.
Under the state’s Certificate of Public Advantage law, the deal would have been shielded from federal anti-monopoly restrictions. Two dozen states have had COPA laws on their books at some point, despite warnings from the Federal Trade Commission (FTC) that such hospital mergers can become difficult to control and may decrease the overall quality of care.
The deal faced immense pushback. Doctors, health economists and the FTC called on the Indiana Department of Health to deny Union Health’s application to merge with HCA Healthcare-owned Terre Haute Regional Hospital.
In an opinion piece in The Indianapolis Star, Sachdev urged regulators to consider the harm that came after similar mergers elsewhere.
“The evidence shows how deals, like the one in Terre Haute, can crush communities,” Sachdev wrote with Zack Cooper, a health economist and associate professor at Yale University.
In November, just days before the state was due to rule on the deal, Union Health withdrew its merger application.
“I was thrilled,” Sachdev said. “The writing was on the wall that it would have been denied.”
Now, Indiana state Sen. Ed Charbonneau, a Republican and chair of the Senate health committee, has introduced a bill to repeal the state’s COPA law. Indiana would become the sixth state to roll back such a law.
Describing Sachdev as aggressive and analytical, Charbonneau said she regularly shares her thoughts about the COPA law and other health-care issues. “Gloria is not at all reluctant to come and talk to me or call me or text me,” he said.
Saving Hoosiers Money
When Braun appointed her as secretary of health and family services, he said in a statement that her “proven track record of transforming healthcare delivery and costs makes her the ideal choice to lead Indiana’s health initiatives.”
Braun’s health-care agenda targets prices that “are robbing Hoosiers’ paychecks,” according to his campaign platform, which adds, “Without intervention, the strain will only get worse.”
In his second week as governor, Braun signed multiple executive orders seeking to increase transparency, directing state agencies to review the practices of pharmacy benefit managers and evaluate pricing. He also has said he plans to build on the legislature's “ambitious work” of tackling affordability. With Republicans in control of the legislature, Braun is unlikely to encounter political gridlock, a reality that excites Sachdev.
“I’ve been working from the ground up, and we’ve made progress,” she said. “If I’m helping Gov. Braun from the top down, we can make faster, greater progress.”
Samantha Liss is the Midwest correspondent for KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling and journalism.
