Wyo’s “Healthy Frontiers” pilot program will never replace Medicaid

By Sarah Gorin
ESPC health policy volunteer

Many Wyoming legislators derisively refer to the Patient Protection and Affordable Care Act (the federal health reforms) as “Obamacare.” This would be a humorous addition to the political debate if these same legislators had an alternative proposal, but at the moment the alternative appears to be “No Care.”

Much has been made of Wyoming’s pilot health care reform program, “Healthy Frontiers.” The program was initially funded by the 2010 Legislature, enrolled its first participants at the end of 2010, and received additional funding from the 2011 Legislature to expand to 200 participants.

Currently, Healthy Frontiers has enrolled just under 20 participants from the targeted pool – individuals participating in state job training programs, whose incomes are under 250% of the federal poverty level, and who live in Cheyenne or Casper (where selected medical providers have agreed to begin implementing the program).

Healthy Frontiers is a health care plan. It is important to understand that it is not health insurance. Healthy Frontiers emphasizes primary care and chronic disease management, with the goal of reducing medical costs over time by taking care of conditions before they develop into expensive crises. This logical approach is being implemented in many model programs across the country, and the ESPC has no quarrel with it.

But Healthy Frontiers also requires participants to pay into to a “personal health account” (not a health savings account for tax purposes), based on income. The ESPC has maintained from the beginning that the required contribution is unrealistically high, based on Wyoming’s Family Economic Self-Sufficiency Standard, which shows the incomes needed to support basic household expenses on a county-by-county basis.

The state also contributes to the personal health account as the client meets certain milestones in the program, such as establishing a relationship with a primary care provider and maintaining compliance with treatment regimens.

Further, the ESPC’s analysis shows that although program proponents hold out Healthy Frontiers as a cheaper alternative to Medicaid, it easily could cost the state more if fully implemented.

The rhetoric from some legislators and Governor Matt Mead about Healthy Frontiers is seriously overblown given the current status of the program. With only a handful of participants to date, and zero data on the workability of the financial requirements or on clinical outcomes, it is wildly premature to talk about this extraordinarily modest program as a substitute for anything.

The problem with the program is a microcosm of the larger health care issue. Americans have made a commitment to providing care to everyone, to not let their neighbors die in the street. But we haven’t yet figured out how to pay for that commitment.

The Affordable Care Act is the first step in that direction, trying to get everyone covered with public or private health insurance so they can pay for their care.

Healthy Frontiers clients earn a painfully low income. Since Healthy Frontiers is not health insurance, if its clients need care above and beyond what is provided by the program, the cost of that care will fall – unpaid – on Wyoming’s hospitals and private providers.

By contrast, Medicaid actually is insurance and pays providers for clients’ care. If you were a health care provider in Wyoming, which program would you like to see behind the consumers coming through the door?

Wyoming’s lawmakers need to lay aside political agendas and focus on solutions that will help our residents access quality health care when they need it and keep our state’s hospitals and providers solvent.