Healthcare advocates are worried about how potential cuts to federal funding could impact Wyoming’s safety net clinics.
The U.S. House passed a budget resolution on Feb. 25 that would require the House Energy and Commerce Committee to make $880 billion in cuts. The committee oversees Medicaid, a federal-state program that provides health insurance coverage and services to low-income people nationwide.
Potential cuts to the program are a big concern for Pete Gosar, the executive director of the Downtown Clinic in Laramie. As part of the National Association of Free and Charitable Clinics, the clinic provides free medical services to about 300 to 400 people without health insurance in Albany County.
According to reporting from KFF Health News, some Republicans have suggested changing Medicaid by adding stricter enrollment requirements, like proof that enrollees are employed, which could leave fewer individuals eligible for coverage.
“Those folks would fall to us and to clinics like ours,” said Gosar. “We might have the same funding source but might end up with another 100 people. So then everybody has less because we’re going to provide care as thoroughly as we can.”
The Downtown Clinic is primarily funded through donations and grants, but their vaccination program, vision services and emergency dental care are supported by federal dollars. Gosar said if that money goes away, they’re going to have to make tough choices about the future of those programs.
“It’s heartbreaking and difficult, because how can we ask people to get a job if they haven’t had glasses? If they haven’t had their eyes checked in 20 years? How is somebody really supposed to hold down a service job when their tooth is infected?” asked Gosar.
Wyoming is also home to multiple Title X clinics. Title X is a federal program started in the 1970s to offer family planning services to low-income people. The program helps fund clinics that provide things like birth control, sexually transmitted infection testing, pregnancy counseling or assistance in achieving pregnancy, regardless of an individual's ability to pay. Wyoming currently receives $978,380 in Title X grants per year, which supports eight clinics, two satellite sites and the Wyoming Health Council, which oversees Title X clinics in the state.
According to the Wyoming Health Council’s Executive Director Gail Wilson, they have been working closely with clinics on contingency plans, asking questions about available reserves and what services might need to change should funding get reduced.
“My belief is we’ll be here, but to what degree and what will it look like?” Wilson reflected. “Will it look like we’re in eight significant communities in the state, or are we going to lose some of our clinics, and how do we address those deserts?”
Gosar with the Downtown Clinic also shared concerns about how changes might worsen medical deserts, or areas where people don’t have sufficient access to healthcare.
“What happens if you’re not in Laramie, where there is a downtown clinic? What happens if you’re in Rawlins or Evanston or Pinedale, where I grew up? What do you do?” asked Gosar. “It’s devastating for communities.”
The Title X program has faced change before. By statute, Title X funds cannot be used directly for abortion services. According to reporting from KFF Health News, in 2019, the Trump administration tightened these limitations by banning participating clinics from providing referrals for abortion or having co-located abortion services. These changes were overturned by the Biden administration in 2021.
Additionally, funding for Title X has remained flat over the last 10 years, not keeping up with inflating healthcare costs. Wilson said most clinics are at a bare minimum with staff.
“Nobody is in this for the money. It’s for the impact for the clients,” she said. “You have to have a passion for it because, like I said, we’ve had gut punches to us for decades since the inception of family planning.”
Wilson is awaiting next year’s budget. But while things feel uncertain, she knows these challenges are not new, which helps her prepare.
“There is comfort in knowing that we just continue on as we always have because that’s what our regulations say right now. And we will address the changes as they come,” Wilson said.
Gosar echoed the sentiment as he shared stories of people who lose their health insurance and need to come to the clinic.
“Do we sacrifice those people? For me, it's pretty easy – it's no,” he said. “How are we going to do it? I don’t know, but we’ve got to do it.”
