As a member of Congress from 2001 to 2013, his deep opposition to abortion led him to initiate efforts to strip federal funding from Planned Parenthood. A Planned Parenthood clinic had been the only place for HIV testing in Scott County, where the outbreak took place. It closed in 2013, largely due to cuts in state public health funding.

A 2018 study from researchers at the Yale School of Public Health estimated that putting in place a robust public health response, including needle exchanges and stepped-up HIV testing, in 2013, when Mr. Pence took office and opioid abuse was quickly growing in the state, would have averted dozens of HIV cases.

Mr. Pence initially refused to expand Medicaid as other, mostly Democratic-led states hurried to do so in 2014, when the Affordable Care Act started giving them the option to do so with the federal government paying nearly all the cost. But he ultimately persuaded the Obama administration to let him expand the program on his own terms, including some that had not been allowed before under federal rules. Mr. Pence designed the plan with Seema Verma, then his top health policy adviser and now the administrator of the Centers for Medicare and Medicaid Services.

Under his program, called Health Indiana Plan 2.0, low-income adults above the poverty level had to pay monthly premiums equaling two percent of their household income, instead of receiving care entirely for free. In a first for the Medicaid program, they could be disenrolled for six months if they failed to pay. Newly eligible adults below the poverty level did not have to pay premiums, but got more health benefits if they did.

“It gives Hoosiers the dignity to pay for their own health insurance,” Mr. Pence said at the time, “and that transaction is important to starting people on a path toward really embracing greater ownership of their health care.”

A state evaluation in 2017 found more than half of those who signed up for the program and were supposed to pay premiums during the first two years failed to do so, most before their coverage even kicked in. Many said the program was confusing as well as unaffordable.