A new report by Natrona County Collective Health Trust found that in the next five years, there will be about 1,000 fewer jobs, over 500 people could move out of the state and $27 million per year could dry up from the state's economy.

That’s due to a provision in the Big Beautiful Bill (BBB), signed into law by Pres. Trump on July 4, that cuts Medicaid spending by $1 trillion in the span of 10 years.

Medicaid uses a mix of federal and state funds to cover health insurance for lower-income Americans. It’s been broadened over the years to cover children and pregnant women, and people with disabilities.

Wyoming never expanded Medicaid, which would’ve made more lower-income adults eligible. This means the state will see fewer impacts than states that have expanded.

The most recent numbers show that about 12% of Wyoming’s population is covered by Medicaid or the Children’s Health Insurance Program (CHIP).

While some may lose their eligibility due to new requirements, and others may lose coverague due to expiring tax premiums on the health insurance Marketplace, healthcare industry stakeholders say federal changes to healthcare coverage funding will have an even greater domino effect on the state’s already fragile system.

Insurance 

As of April this year, 68,445 Wyomingites were enrolled in Medicaid. Due to eligibility changes, the elimination of automatic enrollment and other factors, many may lose coverage.

In addition to the loss of Medicaid coverage, stakeholders are saying many people who buy coverage through the Health Insurance Marketplace will lose their insurance. That’s because the enhanced premium tax credits will not be renewed at the end of this year.

The tax credits lower the cost of monthly payments of plans on the Marketplace. The enhanced version started in 2021. Congress wanted to cap monthly payments at about 8.5% of a person or family’s income. That enhancement was extended but is set to expire later this year. The new law doesn’t renew them.

About 8% of Wyomingites are enrolled in the Marketplace this year.

“ In 2024, about 95% of people in Wyoming who take advantage of the health insurance Marketplace find their premiums to be a little bit cheaper thanks to these health insurance premium tax credits,” said Caleb Michael Smith, Enroll Wyoming’s marketing director. It’s a nonprofit that helps Wyomingites navigate and sign up for Marketplace insurance.

In Wyoming, monthly costs for Marketplace plans could rise up to 194% on average.

Michael Smith gave an example: “ A 60-year-old couple, they make a combined $82,000 a year. Their Silver Plan premiums are currently on average $581 a month. That could go all the way up to $3,700 a month.”

People can use a calculator developed by KFF to see how the expiration of enhanced subsidies in late 2025 might affect their premium payments.

Enroll Wyoming told WPR they expect up to 20,000 Wyomingites could drop from the Marketplace. Some lower estimates from the Robert Wood Johnson Foundation say up to 11,000 could lose insurance from these changes.

“ I've seen what it looks like in Wyoming when waitresses and ranchers and other workers don't have access to healthcare,” said Jenn Lowe, the interim director of Healthy Wyoming, an advocacy group for healthcare access and affordability. “They cannot get treatment for their cancer. They can't get treatment for their diabetes. They get sick, they get delayed care. When it gets to a point that they can no longer manage, they have to go to the emergency room. This is not an effective system. It's gonna become more expensive and it's gonna become less accessible.”

Lowe said people are going to have to start making a choice between paying for food, mortgage, car payment and insurance.

“The folks that are purchasing their insurance through the Marketplace don't have jobs that provide healthcare insurance,” said Lowe. “They're the folks that are self-employed and doing the right thing by purchasing insurance. Making that impossible to afford means people will delay care. People will incur medical debt. Because we're such a small state and because we're so tight-knit in our communities, this is going to impact people. So even if it doesn't impact you directly, the loss of this insurance will have a ripple effect through communities that I don't think anyone is gonna be left untouched by.”

Hospitals 

Since Wyoming never expanded Medicaid, the state will continue matching 50% of the cost of the program alongside the feds. Many are touting this as a victory, since the state won’t have to put more money into Medicaid like other states that did expand to continue covering eligible recipients.

“Wyoming is not a Medicaid expansion state and thus should not see significant changes from the bill in the short term,” said Gov. Mark Gordon in a statement on the passage of the BBB. “However, we will need to continue our work to shore up medical services statewide.”

However, so many people without insurance creates a domino effect that impacts providers and hospitals, according to Eric Boley, president of the Wyoming Hospital Association.

He said it starts with uninsured Wyomingites no longer seeking preventive care.

“ You lose that coverage and they're gonna wait until they're super, super sick, and they'll appear in our emergency rooms, which is the most expensive place to receive care,” said Boley. “And we'll [hospitals] be starting from ground zero, trying to get 'em back to where they're healthy and contribute to society and work and be gainfully employed.”

Those emergency room visits won’t be paid by the patient, which puts more financial pressure on hospitals. Boley said out of the 30 hospitals in the state, only four are currently making a profit.

“ I don't want to get everybody worried about their communities, but people should be paying attention. There are several [hospitals] that have less than 10 days’ cash on hand, which is a very concerning statistic.”

This will make hospitals take a hard look at their budgets. Boley said they will have to make decisions like what services they can stop offering to keep the doors open. Worse, some might need to consider shuttering their doors altogether.

“ It could be home health, it could be a myriad of every service that they'll have to take a look at each one and see which ones they can afford to continue to offer in their communities.”

It could also shutter more labor and delivery departments in a state already short on pregnancy services. In the last year, three departments have closed in Evanston, Kemmerer and Rawlins. About 30% of Wyoming births are Medicaid births. While the Legislature has studied the worsening maternal healthcare deserts in the state, they’ve failed to propose any solutions yet.

Boley said hospitals are going to get creative before they shut their doors to try to make it work.

“I hope what we'll see is our hospitals will do more collaboration and maybe be able to find ways to work together,” he said. “So even though we're losing the service in one community, we might find ways to have it closer than if those services are closed in every community.”

The law includes a new Rural Health Transformation Program that appropriates $50 billion from 2026 to 2030 to help rural hospitals with potential impacts from the law. Boley said hospitals in Wyoming are still studying how this funding will be distributed, “but it could have a positive impact on our rural hospitals.”

Half of the funds will be distributed among states that submit an application outlining a “detailed rural health transformation plan” and are approved. Those applications are due at the end of this year. The other half will be distributed at the discretion of Centers for Medicare and Medicaid Services Administrator Dr. Mehmet Oz.

Sen. John Barrasso (R-WY) recently spoke on the Senate floor about the positive impacts the BBB will have on the Cowboy State, specifically calling out this fund.

“Additionally, Republicans strengthened healthcare, especially in rural communities. There is a Rural Hospital Fund. This directly supports our Wyoming clinics and hospitals,” said Barrasso.

An analysis from PBS found “the $50 billion Congress set aside for the Rural Health Transformation Program covers less than a third of the funding rural communities are expected to lose in Medicaid cuts.”

Nursing homes

Wyoming’s population is aging. The elderly population, defined by the U.S. Census Bureau as 65 and over, is 19.7%. That’s higher than the national number of that population, which is 18%.

About 2,000 Wyomingites are residents at a nursing facility. Seventy percent of those patients are receiving Medicaid.

A silver lining for Boley is that retroactive payments for Medicaid will be 60 days for long-term care patients. The U.S. House originally proposed 30 days.

“ Currently, we're at 90 days, and we're already seeing a delay and some struggles getting those done in a timely manner now. So that's still a concern for us,” he said. “The extra 30 days obviously is nicer than what had been proposed by the House, but what that'll mainly end up doing is probably having our nursing homes taking care of residents without payment for longer periods of time.”

Boley said nursing homes will experience similar troubles as hospitals. Fewer people's care will be covered, which in turn increases uncompensated care. This puts the financial burden on the facility.

He said there’s a potential nursing homes will have to close.

“They're definitely struggling right now. I think the nice thing is we're not seeing specific cuts to the rates that we receive in long-term care. But any disruption in payment or lowering of payments is obviously gonna be problematic for long-term care [and] for all healthcare. But long-term care, they are about 70% Medicaid recipients and so that's a big chunk of change if you take a hit to your reimbursement.”

Economy 

As the BBB was discussed, Natrona County Collective Health Trust was worried about the broader impact to the state’s healthcare system. The Health Trust is a private foundation dedicated to the health and wellbeing of residents of Natrona County.

“When people don't have coverage, when they don't have access to healthcare services, that makes them less healthy and it makes our communities less strong,” said Beth Wrothen, CEO of the Health Trust.

The Health Trust decided to conduct a study on the economic impacts of the Medicaid cuts in the state. They partnered with the Wyoming Community Foundation, the Wyoming Hospital Association, the American Cancer Society and Banner Wyoming Medical Center. The study was done by Regional Economic Models, Inc. (REMI).

“ Medicaid isn't just about healthcare. Medicaid is also a kitchen table issue.  When people are insured, they're more likely to stay healthy, which means they can remain in the workforce and they can spend money in their communities,” said Rachel Bouzis, director of policy and learning with the Health Trust. “It spurs job creation. It can spur job loss.”

Bouzis said that’s what this study took a look at. It found from 2026 to 2030, Medicaid cuts mean there will be about 200 fewer jobs each year then there would have been, and the state will lose $139 million in GDP, $73 million in disposable personal income and 575 residents lost to outmigration.

“ The [job] losses stem from reduced healthcare spending, which goes along with declines in consumer spending, supply chain activity, investment and government expenditures,” Bouzis said.

The report found that besides the loss of healthcare jobs, retail, construction and government jobs would be lost as well. Bouzis said she hopes communities take these numbers seriously.

Wyoming’s delegation

All three of Wyoming’s congressional delegates voted in favor of the BBB.

While they cheered cuts to green energy and support for the fossil fuel industry, they pushed back against concerns that cuts to Medicaid will hurt the state.

“Here’s the real truth: no one is cutting Medicaid. We’re ensuring it remains sustainable for the people it was originally designed to serve for years to come,” Sen. Cynthia Lummis posted to X, formerly Twitter.

“For too long, blue states like New York and California have undermined the dignity of work by expanding Medicaid and food assistance programs in order to enable fraud, waste, and abuse, including to allow illegal aliens to access benefits,” Rep. Harriet Hageman wrote in a July 6 newsletter, which had not yet been posted to her website at the time of publication. “This bill strengthens eligibility requirements, removes those abusing the system, and puts the focus back where it belongs—on hardworking American families in need, including single mothers, individuals over 65, individuals with disabilities, etc.”

“Our bill roots out waste, fraud, abuse and corruption in Medicaid,” Sen. Barrasso said in a speech posted to Facebook in late June. “Republicans will not allow scammers to continue to game the system and steal money from taxpayers.”

KFF reports, “There is no comprehensive or reliable measure of fraud in Medicaid,” that states are as responsible for ensuring the program’s integrity as the feds are and that improper payments are not a measure of fraud. KFF found about 5% of Medicaid payments were improper in 2024, and those were mostly due to insufficient information.

Down the road 

Both Lowe and Boley mentioned they are worried about what the next Wyoming legislative session will mean for the healthcare industry. The session in 2026 is a budget year, which means lawmakers will be looking at the state’s finances. The Wyoming Department of Health has one of the biggest budgets for the state, and Medicaid is a huge part of that.

Just this year, the Legislature passed a property tax relief law that reduced the tax by 25%. Boley said lawmakers are talking about increasing it to 50% next year. Towns, counties and special districts, like hospitals, are already feeling the squeeze. Eighteen hospitals in the state receive a mill levy from property taxes.

“ If we see additional cuts on top of the property tax revenue that our hospitals receive, it's a double-edged sword,” said Boley. “That's what really has me concerned. I haven't heard specifics yet out of any legislators except for the property tax conversation, but obviously it's gonna be something they'll take a really close look at.”

The impacts of the Medicaid cuts won’t be felt immediately. The Marketplace enhanced premium tax credits will expire at the end of this year. People on the Marketplace may start to see plan rates go up in 2026. Meanwhile, the new work requirements and increased paperwork to enroll in Medicaid will take effect in 2027. The restrictions on state-directed payments to hospitals, nursing facilities and other providers will take effect in 2028.