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.

Anti-GLBT bill goes to conference committeee

Legislature agrees to disclosure on independent expenditures in Wyoming elections
Wyoming voters will have to live with the U.S. Supreme Court’s decision that allows corporations to spend freely from their treasuries in independent expenditures to support or oppose candidates for election, but these corporations will have to meet some basic disclosure rules under a law given final approval late Tuesday.

T he U.S. Supreme Court’s decision in Citizens United v. Federal Election Commission leaves voters and potential candidates with the prospect of corporate interests pouring money into state and national elections. It doesn’t matter if you believe that the right to free speech was meant for people who breathe and bleed. The corporations are free to buy the biggest megaphone and to purchase the most speech through independent expenditures in elections that affect their corporate interests.

Nevertheless, the state still has the authority to force disclosure of who finances that megaphone and who buys the time. In its decision in January 2010, eight members of the high court supported the idea that organizations financing independent expenditures can be required to disclose where they get their money.

Senate File 3 – Campaign finance – organizations brings Wyoming campaign finance law into compliance with the Citizens United decision by expressly allowing corporations, unions and other organizations to make “independent expenditures” directly from their corporate funds. These expenditures can be made for or against candidates or ballot measures.

Under current Wyoming law, only candidates, political parties, candidate campaign committees, and political action committees (PACs) can spend money in elections. The ESPC believes corporate speech interests have been served by the ability to form a corporate PAC. These are quite different from the corporation spending allowed by the Citizens United decision because a PAC’s money comes from identifiable and publicly reported officers, directors and shareholders of the corporation.

The 2010 Supreme Court decision means that corporations can dip into their vast treasuries, which can include money earned elsewhere on the globe, far from Wyoming. They can use these funds to make campaign expenditures independent of individual candidates’ campaigns. The independent campaigns are prohibited from coordinating their effort with any candidate committee or party.

Because SF 3 originally required only a “paid for” line on advertising that could easily be used to disguise the actual parties behind an independent expenditure campaign, the ESPC pushed for greater disclosure. The Senate approved an amendment that would have required these campaigns to print the names of their top three donors or read those names when the advertising was provided via television, radio or internet.

House members, feeling pressure from the Wyoming Broadcasters Association, stripped that amendment and instead imposed a disclosure requirement similar to those imposed on PACs and individual candidate campaign committees. The amendment requires the independent expenditure campaign to register with the Secretary of State and to report contributions in excess of $1,000 and expenditures exceeding $500.

The Senate accepted the House amendments Tuesday and adopted the amended bill on concurrence 16-13. Some no votes likely represented some senators’ opposition to the idea of opening state and local elections to direct influence from corporations.

Here’s the roll call on concurrence:
Ayes: Senator(s) Anderson, Bebout, Burns, Case, Christensen, Coe, Cooper, Driskill, Geis, Hicks, Hines, Jennings, Landen, Nutting, Schiffer and Scott.
Nays: Senator(s) Barnard, Dockstader, Esquibel, F., Hastert, Johnson, Martin, Meier, Nicholas P, Perkins, Peterson, Ross, Rothfuss and Von Flatern.
Excused: Senator(s) Emerich

Is it possible HB 74 – Validity of marriage could fail passage?

The Wyoming House Tuesday voted 7-50 to oppose concurring with Senate changes to House Bill 74 –Validity of marriage. Supporters of the bill, which will enable Wyoming to void same-sex marriages made in other states and countries, objected to a Senate amendment that declares the state will recognize civil unions made in other states. Opponents likewise voted against concurrence, hoping ultimately to defeat the bill by demonstrating that there’s no final agreement on it.

A conference committee will now be appointed to attempt to work out the amended changes to the bill. Each chamber will appoint three members to serve on the committee. Rules require that each chamber appoint one member to the conference committee who opposed passage of the bill.

The House appointed two stalwart supporters of the bill, Rep. Amy Edmonds (R-HD12, Cheyenne) and Rep. Kendall Kroeker (R-HD35, Casper), and an opponent, Rep. Jim Roscoe (D-HD22, Wilson) to the conference committee. The Senate is expected to appoint its members to the conference committee Wednesday.

The ESPC’s stand
In any form, HB 74 will discriminate against same-sex couples who have made valid marriage contracts in other states and countries. The ESPC believes such discrimination is contrary to the general philosophy of the Equality State that “all members of the human race are equal.” We urge everyone to contact their legislators and ask them to vote against any proposed conference committee compromises on HB 74.

Interim studies on the agenda

Several House and Senate standing committees met jointly at noon Tuesday to consider possible topics for study during the interim period between the end of the general session and the 2012 budget session. The legislature’s Management Council will meet next week to review and make a final determination on which topics it will authorize for study.
The Joint Corporations, Elections, and Political Subdivisions Committee will study reapportionment – the re-drawing of House and Senate district boundaries to keep those districts as nearly equal in population as possible.

Committee Co-Chairmen Sen. Cale Case and Rep. Pete Illoway announced their plans for a “two-track” process that calls for holding 10 or 11 information-gathering meetings around the state, beginning sometime in April after the committee has new population numbers from the 2010 Census.

All committee members will not be expected to attend all those meetings. But the committee also plans three or four two-day meetings at which it will discuss the reapportionment on one day, then deal with other committee interim topics on the second day.

Rep. John Patton (R-HD29, Sheridan) asked the committee to avoid imposing constraints on the public discussion of the redistricting options. He said that suggestions from the chairmen that the Legislature retain the same number of House and Senate seats (60 and 30 respectively), continue to “nest” two House districts within each Senate district, and to presume that districts will be single-member districts are inappropriate constraints on public discussion.
“It makes it convenient for us,” he said. “Let them (the public) speak first.”

Illoway told Patton and the committee that while a decision to end “nesting” is possible, physical constraints, such as the size of the House and Senate chambers, must be recognized. “It’s very difficult to put more people in this Capitol,” he said. (That's a photo of the Senate chambers above.)

Appointments
New Gov. Matt Mead released his list of proposed appointments to state boards and commissions Tuesday. The Senate has five days to approve or reject Gov. Mead’s chosen appointees.

Participate
Citizens can register their opinions on specific legislation by using the “Online Hotline” or the telephone Hotline – 1-866-966-8683 or, in Cheyenne, 777-8683.

House Education panel passes DOMA bill

Back of the bus for Equality State gays

The House Education Committee Monday night approved a bill that would clear the way for Wyoming to deny the validity of same-sex marriages legally made in other states or countries.

The committee voted 7-2 to send the bill to the House floor with a do-pass recommendation after opponents of the measure noted the irony of approving legislation limiting the legal rights of the state's gay residents on Martin Luther King Wyoming Equality Day.

Earlier in the day Gov. Matt Mead had addressed celebrants who honored Dr. King's memory by marching to the Capitol at noon.

“In his acceptance speech for the Nobel Peace Prize, King spoke of his audacious belief that peoples everywhere could have three meals a day for their bodies, education and culture for their minds," the new governor said, "And dignity, equality and freedom for their spirits.”

“Food for the body, mind and soul are not things to be taken for granted. Not everyone has enough of it and we must continue to strive to provide it for all of our citizens. The work is not done,” the governor said.

But the Education Committee did not get the message. Advocates for the bill stayed on message, asserting that the legislation, House Bill 74 - Validity of marriage will protect the integrity of marriage. The law declares that marriages "other than of a male and a female person are void."

How gay relationships threaten heterosexual marriage was not made clear.

Lead sponsor Rep. Owen Petersen, R-HD19, Mountain View, (pictured above) said legislators must protect traditional heterosexual marriage as one of the key building blocks of society. The federal Defense of Marriage Act (DOMA) allows states to void legal marriage contracts made in other jurisdictions even though the Commerce Clause of the U.S. Constitution generally requires states to recognize legal contracts made in others.

Jason Marsden, formerly a lobbyist for Wyoming Conservation Voters and now executive director of the Matthew Shepard Foundation in Denver, attended the hearing to remind legislators that they really do not know the people the legislation will affect both legally and economically. He said later that most legislators certainly would go out of their way to understand how a change in water policy would affect a few irrigators or a small community.

They don't bring that same concern to members of the gay and lesbian community, he noted.

Rep. Cathy Connolly, D-HD13, Laramie, laid out a long list of arguments against the bill. She warned that adopting the bill threatens economic development by making the state less attractive to skilled professional couples who happen to be gay. But she also noted the personal affront to her as a lesbian who raised a son in a deeply committed relationship.

Connolly and Rep. John Freeman, D-HD60, Green River, cast the two no votes against HB 74.

Reps. Bob Brechtel, R-HD38, Casper, Donald Burkhart, R-HD15, Rawlins, Rep. Kendell Kroeker, R-HD35, Casper, Sam Krone, R-HD24. Cody, Carl "Bunky" Loucks, R-HD59, Casper, and Michael Madden, R-HD40, Buffalo, and Chairman Matt Teeters, R-HD5, Lingle, voted to pass the bill.

Short takes

• The Senate Judiciary Committee heard testimony for two hours on SJ2 - Health Care Freedom and SJ3 - Health Care Freedom (2). Both challenge the Affordable Care Act. SJ2 is a nullification bill likely in violation of the Supremacy Clause of the U.S.Constitution. That has not stopped its advocates who include lead sponsor Sen. Leslie Nutting, R-SD 7, Cheyenne, and the Wyoming Liberty Group. Testimony resumes Wednesday at 7 a.m.
  
• The Senate Corporations Committee Tuesday morning will consider SF3 - Campaign finance - organizations. The proposed bill brings state campaign finance law into compliance with the U.S. Supreme Court's 2010 decision that corporations can spend directly and freely through independent expenditure campaigns attacking or supporting specific candidates. The ESPC is advocating comprehensive disclosure laws so Wyoming voters can identify the sources of funding for those independent expenditures.
• Senate File 14 - Counties - election districts also will be heard by Senate Corporations. The bill allows a county to set up commission voting district that would allow some commissioners to be elected at-large in part of a county and by district in others. The ESPC fears the state is simply erecting another racist structure in the wake of federal court's dismantling of an existing one. Last spring, U.S. Distrct Court Judge Alan Johnson ordered Fremont County to end its system of at-large commission elections because they diluted the Native American vote. That dilution made it virtually impossible for a member of that large minority group to win a commission election.