CASPER, Wyo. — The new state-run Healthy Frontiers health insurance pilot project seems to have more critics than clients.
One woman, however, says it may have saved her life.
“I could have died, and I did not know that,” Debbie Milder of Casper said late last week.
The 46-year-old divorced mother of a 3-year-old son has a part-time job with a law firm but no health insurance. She doesn’t qualify for any government assistance programs. But she met the Healthy Frontiers criteria, which is designed to demonstrate that preventive treatment for people with no health coverage will save money in the long run.
Healthy Frontiers requires that all clients see a physician for a complete physical examination. Milder said her complaint during the exam was constant fatigue. Her physician ordered tests that disclosed she has severe sleep apnea. The program paid for the diagnostic studies and the machine that keeps her airway open at night.
The program also paid for a short hospital stay when Milder experienced chest pains. Additionally, it covers the cost of nearly all of her medications.
In order to maintain her eligibility, Milder must visit her physician three times per year. She has received counseling on diet and exercise and regularly completes a questionnaire about tests and services she has received.
Milder pays about $9.50 a month, which the program takes from her health care savings account. The amount paid by Healthy Frontiers clients is based on federal poverty guidelines. The out-of-pocket cost ranges from $9.03 to $72 per month.
Program officials deposit money into a client’s account periodically as steps are completed to reach a wellness plan.
Milder said she never could have paid for the costs of the tests, treatment and equipment for her medical problems.
“It would have killed me financially,” she said. “There was no way I could do it.”
She is baffled over why more eligible people don’t enter the program. Only 49 people were participating as of last week. The 2010 state law authorizing the program limited enrollment to 500.
Program officials say Healthy Frontiers’ preventive approach is driven by the fact that statistics show only a small percentage of the population is responsible for half or more of the costs of health care.
If the program proves successful, supporters say, it could provide an inexpensive alternative for people who have no health insurance.
The clients who qualify for the program are those without health insurance who earn too much money to be eligible for the Medicaid program for low-income people.
Program officials expanded efforts over the summer to reach Healthy Frontiers’ target population outside of those already in the Wyoming Department of Workforce Services programs. They sought people working with CLIMB Wyoming for single mothers, Dads Making a Difference for single fathers and parents of children in the KidCare health insurance program.
“It think the word has been getting out,” said Wendy Curran, senior director for planning and program development for Blue Cross-Blue Shield, the administrator of the Healthy Frontiers project.
The program now has five participating physicians groups, including two each in Casper and Cheyenne and one in Powell.
One patient who enrolled was diagnosed with diabetes, while another had uncontrolled asthma.
“These are the kinds of diseases we’re trying to catch,” Curran said.
Dr. Paul Johnson is a Cheyenne ear, nose and throat specialist and a Wyoming Medical Society trustee. He said he supports the program but likes the fact that it currently is a pilot project.
“It’s not something I’m advocating statewide until we see the data,” he said.
Johnson said early indications are that the program is well-received despite the small number of clients.
“Our goal is to have more effective use of health resources,” Johnson said.
He noted that clients who are required to visit their health providers more regularly can receive preventive care to control existing conditions that could be costly in the future.
One barrier that may be keeping more eligible people from enrolling is the requirement they work at least 20 hours a week. And even though the premiums are adjusted according to income, the monthly payout may also deter potential participants.
Sen. Michael Von Flatern, R-Gillette, is a member of the Legislature’s Joint Appropriations Committee. He said the committee may need to look at the eligibility requirements.
Sen. Charles Scott, R-Casper, is the chairman of the state Senate’s Labor, Health and Social Services Committee and chief sponsor of the project. Scott said he wanted a large enough client base to demonstrate the program’s effectiveness in controlling health care costs.
“The intention was great,” he said. “We were going after a group that needed the coverage, and we needed to weed out those who would game the system.”
Meanwhile, critics are amplifying their complaints about the program. The conservative Wyoming Liberty Group recently published a series of articles criticizing the project for its cost and lack of public support.
The original project authorization bill, which easily passed the 2010 Legislature, limited enrollment to 500 participants. It allowed for up to 2,500 participants the first year with the governor’s approval.
The 2010 Legislature appropriated $25,000 for administration and $750,000 for program costs from the tobacco settlement trust account.
The law requires completion of the demonstration project by July 1, 2015 and a delayed repeal date of Dec. 31, 2015.
Last winter, the Legislature extended the original $750,000. It also added $1.5 million to establish a reserve account with the Wyoming Health Department for excess claims, and it allocated $1 million from the state general fund to the Wyoming Insurance Department to operate the program by contract with the Wyoming Health Insurance Pool.
The Joint Appropriations Committee will take a close look at the project later this year and during the budget session beginning in February.
Some lawmakers are either skeptical of or outright opposed to the program, committee co-chairman Sen. Phil Nicholas, R-Laramie, said.
Committee member Sen. Curt Meier, R-LaGrange, said he is among the skeptics. He said the project has gone forward only because the people on the legislative committee worked so hard to get it through.
House Majority Floor Leader Tom Lubnau, R-Gillette, said his concerns about the demonstration project are “science-based.” He doesn’t believe enough people can be involved to establish credible data.
“Wyoming, as a pool, is too small to be considered statistically significant,” he said.
Last session, at the request of a lot of people he respects, Lubnau said he allowed the bill that added money for the project to go through the House without a lot of opposition.
Lubnau said he will be critical of the program the next time it comes up for debate.
Yet Lubnau also said it is equally critical that Wyoming examine all of its health coverage options. He noted significant state spending on health care through workers compensation and employee health insurance, in addition to more than half a billion dollars a year on the Medicaid program, the latter mostly for low-income children and nursing home care.
Sen. Scott said the idea for Healthy Frontiers came from a group of conservative Republicans. He said the state needs to prove to the federal government that Healthy Frontiers will work, even if Congress repeals the federal Affordable Care Act.
If the Affordable Care Act isn’t repealed, he added, the state will face big budget increases if Medicaid is expanded to cover low-income, single adults. Scott said he doesn’t see where the state can find the $60 million or $70 million per year to cover increased costs if that happens, and it could trigger a sales tax increase to pay for it.
“This is an option to avoid a lot of nasty decisions,” Scott said of Healthy Frontiers.
Some lawmakers say the program should be cost-effective if it catches patients with serious disease early.
“If it’s not working, we need to find out why it doesn’t work,” said Sen. John Schiffer, R-Kaycee, a member of the Senate Labor, Health and Social Services committee.