March 21st, 2008

Star-Tribune staff writer
Tuesday, February 26, 2008 2:06 AM MST

A health care reform bill moving through the Legislature was created without the help of a state board charged with addressing the cost, quality and accessibility of health care for Wyoming citizens.

Some members of the Wyoming Healthcare Commission said they did not get a look at Senate File 85 until after the Legislature had. And the commission has questions about the bill that it feels should be answered before the measure moves forward, said Susie Scott, executive director of the commission.

The bill, spearheaded by Sen. Charlie Scott, R-Casper, creates an insurance pool for people who have entry-level jobs but make too much to be on Medicaid and don't get insurance through work.

"It's important due diligence is done with any legislation and the hard questions are asked," Susie Scott said. "I think it's important for any entity involved in health care reform to clearly communicate with other resources."

In a letter to Gov. Dave Freudenthal and Sen. Charlie Scott dated Feb. 15, the Healthcare Commission asked about the target population of the $1.2 million project, the impacts of the bill and the sustainability of the program.

It's more of a work force bill than a health care bill, said Dixie Roberts, chairwoman of the commission.
"It doesn't follow the route we were looking at," Roberts said. "We can't support it, because we don't know about it."


Charlie Scott said the bill came from ideas discussed within the governor's office.

He said he received a call in January from Dr. Hank Gardner, a health benefit design specialist in Cheyenne, about providing an insurance product for about 500 people in work force development. The idea was that the state could test theories about expanding health coverage on this small population.

"The commission came up with a proposal that didn't have cost control, and we turned it down," Charlie Scott said. "They probably do not have the expertise to come up with something like this."

The bill made it through the Senate Monday, and the House is expected to hear the measure later this week.

Dan Neal, director of Equality State Policy Center, calls the health care reform pilot project a "fairly significant effort to change health care." He said he is confused why it didn't go through the commission.

"Why do we have the Healthcare Commission if you can put a few heads together to spend $1.2 million?" Neal asked.

Neal is concerned with the portion of the bill that says, "The administrator should have power to limit enrollment and, if necessary, to disenroll individuals to avoid overspending."

The administrator can drop people from the insurance program if appropriations run low, Neal said.

"If they disapprove of how someone is responding to the preventative programs, they can drop them," Neal said. "What insurance company in America wouldn't want that power?"

Wendy Curran, health policy adviser to the governor, said she didn't think SF 85 was significantly different from what the Healthcare Commission proposed. She said the bill deals with preventive care and disease management.

The bill targets a small population that is between Medicaid and jobs with benefits, Curran said.

"When people are successful at leaving Medicaid, they are still working at a low-income job that probably doesn't provide health insurance," Curran said. "Sometimes their only choice is to quit their job and cycle back through the state system."

Based on data from Gardner, Charlie Scott said these people are heavy users of health care.

Gardner, president of Human Capital Management Services, collects health data for Wyoming. He said this is a four-part system that includes a prevention program, health savings accounts, a high deductible and a disease management program.

The bill creates a benefit design committee that will decide how much co-payments and deductibles will be and how the benefits will be distributed. Curran said officials aren't sure who would be on the committee.

'A lot of questions'

Charlie Scott and Gardner both say the program would reduce health costs because it would help people manage their health better.

The program is just a pilot project, Charlie Scott stressed, intended to figure out which theories about covering the uninsured work and which don't.

He wanted a small bill because he said states that have undertaken large health care reform have experienced a lot of financial problems.

Roberts said it will be difficult to see what type of impact the state can make with only $1.2 million and fewer than 500 people. Charlie Scott said he's just trying to get something started.

"We don't have enough people involved to get statistical analysis," he said. "We will probably be back in two years to get more money for more people."

Gardner said 500 people "is a statistically significant population." His company will do the analysis of how the program is working.

"Five hundred is not that big, but you can still learn how it works, how to enroll people and how to collect data," Gardner said. "It's a very important step -- a cautious step, but a very informed one."

Curran said she didn't think there was a conflict of interest between Gardner helping create the program and analyzing the results of it.

The Healthcare Commission and Neal both said they were excited to see the Legislature working on covering the uninsured, but the bill needs some work.

"There are a lot of questions," said Neal, whose organization represents labor unions, the Wyoming Outdoor Council, the Wyoming Education Association, the Wyoming Association of Churches, the Wyoming Wildlife Association and the Wyoming Trial Lawyers Association. "Maybe they can resolve them, but a lot of this needs to be clarified."

Contact health reporter Allison Rupp at (307) 266-0534 or