The Demise of Healthy Frontiers

By JP Eichmiller

March 9, 2012

The final chapter of the Healthy Frontiers Demonstration Project was written this week in the chambers of the Wyoming Capitol when legislators voted to terminate the program.

In a legislative session marked by talk of spending cuts and budget restraint, legislators were unwilling to continue funding the controversial health demonstration project championed by Sen. Charles Scott, R-Natrona. This was despite the fact that Sen. Scott was not asking for additional appropriations, only an extension of the operating deadline. Healthy Frontiers proved unable to overcome its growing reputation as a costly and ill-advised venture for the state of Wyoming into public health care.

Against a growing swell of opposition in the Legislature, Sen. Scott gave his all to keep Healthy Frontiers alive. Just days before the start of the Budget Session, Sen. Scott submitted a bill extending the project’s sunset date by one year to July 1, 2013. Senate File 91 received the two-thirds vote necessary for introduction in the Senate and appeared well on its way towards Senate approval just last week.

But then Sen. Scott, perhaps sensing the chorus of opposition to Healthy Frontiers emanating from the House of Representatives, elected to take a different course. On Monday, February 27, Sen. Scott introduced an amendment to the Senate budget appropriations bill (Senate File 1) which mirrored the language of SF 91.

“It’s a precautionary amendment in case [SF 91] didn’t go through,” said Sen. Scott in explaining his double-down method of legislating. “Funny things happen in this place.”

And as Sen. Scott predicted, funny things indeed happened.

Two days after accepting Sen. Scott’s budget amendment, his peers in the Senate rejected SF 91 on the third reading, killing the bill before the House even had a chance to sink its teeth into it.

By eliminating SF 91 and inserting identical language into the budget bill, the Senate essentially circumvented the need for a full House vote in order to keep Healthy Frontiers alive. According to precedent, neither chamber holds full body votes to opposing house amendments to the budget. Instead, both houses appoint five members to serve on a Joint Conference Committee (JCC) that works to resolve any differences in the budget bills. The move was a calculated gamble by Sen. Scott that Healthy Frontiers stood a better chance of survival before the JCC than the entire House body.

The practice of inserting bills as budget amendments, while not unprecedented, is often frowned upon by legislators who see it as a backdoor method of legislating. “Some legislators will see an amendment inserted into the budget and question why it wasn’t passed through in bill form,” Rep. Rosie Berger, R-Sheridan.

The spectacle of ten legislators meeting to haggle over the finer points of the state’s multi-billion dollar budget represents congressional horse trading at the highest level. Prior to meeting, legislators on the JCC receive direction from leaders and peers in their respective house on what amendments can be sacrificed, which need to stay and which ones can be further amended in some form.

“We discuss with House members about what you want and what you don’t want to lose [from the budget bill],” said Rep. Berger.

Rep. Berger, co-chair of the Joint Appropriations Committee spent nearly two years crafting the proposed budget and served as the lead House representative at the JCC meeting. “We’ve heard from all of the agencies, we know what the Governor’s recommendations are.”

Unfortunately for Sen. Scott, diverting Healthy Frontiers into the budget bill did not go unnoticed by House members.  Speaker of the House Ed Buchanan, R-Goshen, an open opponent of the program, made clear he had his sights set on taking down Healthy Frontiers.

“Leadership really sent the message that we were opposed to Healthy Frontiers,” said Rep. Berger.

“There has been resistance [to Healthy Frontiers] on the House side since the beginning,” said Rep. Sue Wallis, R-Campbell, who also was appointed to the JCC. “In the House as a body, the votes to support [Healthy Frontiers] were pretty slim.”

It is also possible that Sen. Scott did Healthy Frontiers a disservice last week when he unilaterally killed a House bill (HB 119), sponsored by Rep. Buchanan. Sen. Scott, the acting chair of the Senate’s Labor, Health and Social Services Committee, refused to allow the bill — which had already passed the House – a vote by the entire committee. Scott claimed HB 119, which would have allowed Wyoming residents to shop for insurance from other states, required too many revisions to consider for Senate introduction.

And so last Friday evening, when much of Wyoming’s workforce had retired for the weekend, the ten members of the JCC continued work into the night crafting out a final compromise to Wyoming’s biennium budget. With 106 amendments to consider, it was the responsibility of the JCC to separate the wheat from the chaff and come out with a budget proposal palatable to the whole Legislature and ready for the Governor’s signature.

When Sen. Scott’s amendment came up for consideration, the end was quick and merciless. A majority voice vote was all it took, and the program was deleted.

Word of the demise of Healthy Frontiers spread quickly through the Capitol.

On Monday, speaking on a proposed amendment to the Medicaid Options Study bill (SF 34), Rep. Buchanan requested any language alluding to the Healthy Frontiers program be deleted from the bill. “Healthy Frontiers failed in the Conference Committee,” said Buchanan.  “It won’t even be in the budget.”

Rep. Elaine Harvey, R-Big Horn/Park, a supporter of the project since its inception, offered a more emphatic eulogy. “Obviously, Healthy Frontiers is dead.”

Sen. Scott, however, was not yet willing to waive the white flag of surrender. The last option available to salvage Healthy Frontiers was to garner a majority of Senate votes and reject the JCC budget recommendation.

Such a move, however, is unlikely in the Legislature. Were the JCC recommendation to be voted down by either house, all previous agreements would disintegrate. A second Joint Conference Committee would be nominated and the entire budget – not just the opposing amendments – would become fair game for revision. This option was hardly palatable to a legislature looking to conclude business by the end of the week.

When the time came Monday for Sen. Phil Nicholas, R-Albany, to present the Senate with the JCC report, he initially neglected to even mention the deletion of Healthy Frontiers.

When the floor was opened for comments, however, Sen. Scott ensured his opinion his heard.

“One of the things this conference report does is eliminate the Healthy Frontiers program,” said Sen. Scott. “That’s a fundamental mistake, and sufficient in my judgment to cause us to vote this budget down.”

Sen. Nicholas did his best to empathize with Sen. Scott. “It is a difficult position to be in when you’re conferencing on a project… that failed in a bill form on our side but made it in the budget.

“It is a conflicting position. There was little to no support on the House for that position… the best I can do is explain that we weren’t insensitive… but that’s the result.”

The roll was called and the Senate voted 25 to five in favor of the JCC budget recommendation. The House of Representatives concurred and Thursday morning, Gov. Matt Mead signed the bill into law, thereby sealing the fate of the Healthy Frontiers Demonstration Project.

Healthy Frontiers never lived up to the lofty expectations of its sponsor. Sen. Scott sold the program to legislators in 2010 as a cost saving, Wyoming alternative to Medicaid. However, as time when on and questions to the future funding of Healthy Frontiers were raised, Sen. Scott made it clear the ultimate intent of the program was to qualify as a Medicaid waiver program:  i.e., Medicaid expansion.

The more legislators learned about Healthy Frontiers, the greater their concern grew. The program was plagued by low enrollment and a lack of health care providers willing to work within its rules. Estimates proved Healthy Frontiers was likely to cost Wyoming more per enrollee than Medicaid recipients. And due to the program’s caps on benefits, restrictive enrollment requirements and premium policy, it was unlikely – if not impossible – that Healthy Frontiers would ever qualify for the federal Medicaid waivers needed to lower the state’s financial burden.

“Some Representatives are just uncomfortable with creating a local version of the federal mess,” said Rep. Wallis.

Healthy Frontiers was also plagued by its inability to prove itself a viable alternative to Medicaid. The concept of Healthy Frontiers is credited to Dr. Hank Gardner, founder and Chief Executive Officer of Human Capital Management Services (HCMS), a Cheyenne based healthcare consulting firm. Although never confirmed by Gardner, Healthy Frontiers’ design closely resembled Indiana’s fledgling Healthy Indiana Plan.

In 2011, Wyoming Liberty Group conducted a months-long investigative report into the research and data that went into developing Healthy Frontiers. Despite numerous interviews and public records requests with the involved state agencies, insurance companies and HCMS, no data evidence was ever produced to show why the state believed the program would work. The only evidence of what went into designing Healthy Frontiers was the millions of dollars worth of state contracts granted to Gardner and HCMS.

Sen. Scott eventually conceded that Healthy Frontiers was based more on theory than hard evidence.  All the project needed, he said time and again, was greater funding, a larger enrollment and more time. In the end though, the project’s lack of success was enough evidence to prove to legislators that Healthy Frontiers was a losing gamble paid for with state funds.