Thursday, May 14, 2015

Health reform task force co-chairs unhappy with consultant choice, seek to nix contract

Posted By on Thu, May 14, 2015 at 8:50 AM

click to enlarge COLLINS: Majority rules unless we pick the wrong choice.
  • COLLINS: Majority rules unless we pick the wrong choice.
A little bit of drama is brewing on the Health Reform Legislative Task Force: the task force’s GOP leadership was on the losing side in selecting a consultant, and now they're seeking to overrule the vote. 

Last week the task force — which is charged with examining possibilities for the future of the private option and health care in the state — voted 9-7 to offer a consulting contract to the Stephen Group of New Hampshire, which beat out the Boston-based Public Consulting Group (PCG).

Yesterday afternoon, the co-chairs of the task force, Rep. Charlie Collins and Sen. Jim Hendren, sent an email to all task force members stating that they planned to “share [their] concerns” about the choice with the Legislative Council, which must approve the contract (the Council’s Executive Subcommittee meets this afternoon). The co-chairs will recommend that the Council not approve the contract for any firm this week – the task force would go back to the drawing board and try to reach “consensus.” You can see a full copy of the email, acquired by the Times, below. The gist: Hendren, Collins, and other lawmakers who voted for PCG are so displeased with the selection of the Stephen Group that they are going to push Legislative Council to block what is technically the recommendation of the task force.

Some of the task force members who made up the majority voting for the Stephen Group are understandably not thrilled by this maneuver. In a reply to the email from Hendren and Collins, Sen. Linda Chesterfield wrote, “I am extremely disappointed with the ‘if I can't have my way, I'll take my ball and go home’ attitude expressed in this little update.’” (Chesterfield’s full reply, also acquired by the Times, is below; I’ve been told there were a number of other colorful replies).


A little background: We mentioned last week that the voting blocs were strange: all four Democrats voted for the Stephen Group, along with five far-right Tea Party Republicans. Meanwhile, the votes for PCG were a mix of Republicans—some who had previously supported the private option, some who had previously been against it: Collins and Hendren, along with vice-chair Sen. Cecile Bledsoe, private option architect Sen. David Sanders, and three other GOPs. See here for more on why the votes broke the way they did.

As we noted last week, some GOP backers of PCG – including folks on both sides of the private option debate – were adamant that the selection of the Stephen Group was a mistake. They argued that PCG offered the most promising new ideas that might lead to task force members finding common ground and expressed concerns that the Stephen Group's proposal would not meet the requirements demanded by the contract. Rumors have been floating ever since the vote that this camp might try to stop the Stephen Group contract from moving forward in Legislative Council. 

The letter from from Collins and Hendren focuses on a lack of consensus: "In our joint view, moving forward with a contract worth over 1 million dollars on a recommendation receiving just over 50% support from the task force, greatly diminishes our chance for success." They argue that the task force must reconvene to reach a "broader consensus" and state that currently, "many…members [have] significant concerns about one or the other of the consultants." 

I don't have a dog in the fight over which consultant gets chose but let's just say that this consensus argument doesn't really pass the smell test. If Collins, Hendren, and co. had won the vote and PCG had been selected 9-7, it's hard to believe that they would back out of the recommendation because there was a split on the task force. This is simply a power move. They believe the majority of the task force is making a major error and they're trying to stop it. 

A number of lawmakers — both Dems and Tea Partiers — who voted for the Stephen Group are now furious, believing that the task force leadership is trying to subjugate the process in order to get their way. Even legislators who didn't have strong feelings about the choice of consultant say they're demoralized by what they view as strong-arm tactics which damage the integrity of the process. "What's the point of the task force?" one lawmaker asked. "If Jim Hendren already had a plan, why didn't he present it to the legislature instead having us read 3,000 pages of proposals and 18 hours of testimony?" 

Worth noting in terms of the optics: the Stephen Group's bid was around $1 million and PCG's was $2.2 million. We're talking about a program that involves more than $20 billion in federal spending over ten years, so the difference in consulting price tag shouldn't be the determining factor here, but it's an easy talking point for lawmakers unhappy with the Hendren/Collins letter. (That price difference may be an illusion: the SG contract runs through October of 2015; PCG's runs through the end of 2016, which was a requirement of the contract's request for proposal. There's a pretty good chance Stephen would have to revise upwards to fulfill the contract.) 

Chesterfield's letter suggested that Hendren and Collins were representing the view of Gov. Asa Hutchinson. "To inject the Governor's position into the debate at this time is unwarranted and in poor taste," she wrote. However, the governor has offered no public position and it's not clear that the governor's office was involved in this maneuvering. Of course it's reasonable to wonder about that given that Hendren, his nephew, worked closely with the governor on establishing the task force to begin with. UPDATE: The governor's office told me they have no position on the consulting contract and had no involvement in the Hendren-Collins letter or any negotiations around the contract. 

Hutchinson's surgeon general, Greg Bledsoe, told me that "the governor is neutral." Bledsoe, a non-voting member on the task force, said that members asked him who he personally preferred and he stated PCG. "It was mainly due to my respect for the McKenna subcontractors," he said (McKenna Long & Aldridge is a U.S.-based international law firm which has done health care consulting work in Louisiana, Mississippi, Missouri, Tennessee, and Utah). "I do not oppose Stephen Group but simply want to make sure task force has [the] ability to do what it's been asked to do, and has support from whichever consultant is finally selected."

Bledsoe, at the request of the chairs, contacted McKenna to see if they would partner with the Stephen Group instead. McKenna politely declined, stating that it could not ethically break with PCG at this point. Bledsoe then contacted PCG at the request of the chairs and asked whether they might be interested in partnering with the Stephen Group (according to Bledsoe — if and only if SG was fully on board with a partnership). According to lawmakers in communication with the Stephen Group, the call from PCG heavy-handed, essentially arguing that the Stephen Group may have won the vote, but they were not actually going to be tasked with the heavy lifting on the consulting contract (Bledsoe told me this was not the message he delivered to PCG). 

As I've said before, I'm skeptical that the choice of consultant matters that much — this is already one of the most studied, analyzed, and reported-on statewide health programs in the country. The task force faces lots of complicated little questions but the big question is simple: will the state continue to accept federal money to cover its poorest citizens or not? 

That said, as an exercise in coalition-building, this looks like a disaster. In particular, Democrats say that they weren't pushed to vote one way or the other. Presumably, the four Democrats could form a voting bloc with the Republicans on the task force generally supportive of continuing some version of the private option, but Dems were in the dark (in fact, even the Dems voting together for Stephen may have simply been luck — at least one told me that there was no plan for them to vote as a group). At this point, it won't exactly build trust with anyone that leadership conducted a vote, only to now push for ignoring the results. 

The Legislative Council Executive Subcommittee meets at 3 p.m. today and the full Legislative Council meets tomorrow morning. Expect some fireworks. 

Here is the email from Collins and Hendren (see below for the response from Chesterfield): 

Dear Task Force Members,

We wanted to pass along another update regarding the contract negotiations.

Jill and Marty have been working diligently to finalize a contract with The Stephens Group based on the RFP and direction of the Task Force. It is due for presentation at 3:00 P.M. tomorrow at ALC- Executive Mtg.

Assuming they are successful, the co-chairs want all task force members to know our intentions.

The Task Force vote on the final two consultants was 9-7, with many Task Force members having significant concerns about one or the other of the consultants. It's important to have broad task force support for moving forward on a major decision like this.

In our joint view, moving forward with a contract worth over 1 million dollars on a recommendation receiving just over 50% support from the task force, greatly diminishes our chance for success. It is reasonable that before ALC approves a contract for over one million dollars they should know that seven members and the Governor's representative do not believe that the consultant's proposal fully addresses the comprehensive needs of the task force.

These concerns have left the co-chairs with a difficult decision. While it is clear that the recommendation of the task force must be presented and considered, it is also clear that we have an obligation to disclose our concerns that moving forward with this contract at this time will not give us the ability to deliver the Medicaid Reform solutions we are tasked to provide. Our intention is to present the contract and also share our concerns. We will present the proposal to ALC-Executive Subcommittee tomorrow and full ALC on Friday and be clear that this was the recommendation of the majority of members of the task force. However, we will also state our concern with a proposal for this amount that nearly half of the task force considers to be less than what we need to achieve our goals. It is our recommendation that a contract NOT be offered to ANY firm at this time. We believe we need to explore other alternatives that have broader consensus.

The decision to approve/deny approval with this contract will be then be in the hands of ALC. If ALC determines to approve the contract, you can be sure that we will work diligently with The Stephens Group to achieve the best results for Arkansas.

Moving forward, we learned that we should be explicit in ensuring we have broad alignment on major decisions like selecting a consultant partner.

Respectfully,
Jim Hendren/Charlie Collins

Here is the response from Chesterfield: 

Dear members,

I am extremely disappointed with the "if I can't have my way, I'll take my ball and go home" attitude expressed in this little update. Everyday as legislators we live with the knowledge that sometimes our positions are upheld by one vote or no vote. This situation is no different.

To inject the Governor's position into the debate at this time is unwarranted and in poor taste. It smacks of giving credence to the untenable position that "when my side wins it's okay, but when the other side wins, we need to shut everything down." I was assured from the outset that my belief that the process was greased was wrong. I see I was right.

I will live with what the majority of Council wants, but I am sorely disappointed in the fact that some majorities are more worthy than others. How do we work together to achieve a common goal? How do we build trust with each other? How do we pretend that the gridlock that embarrasses our US Congress has not permeated the politics of this state?

Disappointed prognosticator,

Linda 

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