Wyomingites in the healthcare sector are concerned the U.S. House’s version of the One Big Beautiful Bill will further break down the already fragile healthcare system in a rural and low-population state like Wyoming. Proposed Medicaid cuts and potential changes to the health insurance Marketplace are most concerning, on top of frozen grant funds.
Wyoming Public Radio’s Nicky Ouellet chatted with WPR’s Kamila Kudelska about what she learned from several stakeholders about potential impacts.
Editor’s Note: This interview has been lightly edited for clarity and cohesion.
Nicky Ouellet: Kamila, let’s start with the basics. Remind me who Medicaid benefits.
Kamila Kudelska: Medicaid started in 1965 and was designed to cover healthcare for lower-income Americans. It uses a mix of federal and state funds. It’s been expanded to also cover children and pregnant women, and people with disabilities.
I do want to point out that Wyoming is one of the few states that never expanded Medicaid, which would’ve made more lower-income adults eligible. This means we’ll see fewer potential impacts to the state if the program’s funding is cut.
The most recent numbers show that about 12% of Wyoming’s population is covered by Medicaid or the Children’s Health Insurance Program (CHIP).
NO: How will this chunk of population be affected if the proposed cuts go through?
KK: It’s a moving target. There are a lot of proposed changes in the details of how Medicaid works.
Wyoming Hospital Association’s President Eric Boley said he’s most worried about limiting retroactive payments to a single month. Currently, Medicaid covers three months [of retroactive payments]. That’s because it can take a while for applications to get OK’ed.
Eric Boley: In the meantime, we have these folks that are admitted into our nursing homes, or we have children that need coverage or mothers, or pregnant mothers. They're gonna have two months where those folks may be receiving care and are eligible for Medicaid, but because of the process of getting it done, instead of getting paid for the entire time, they're [providers] only getting paid for one month of that care.
KK: He says this could increase unpaid care in hospitals and nursing homes in the state. And even if they [patient] are covered by Medicaid, [the program] already doesn’t cover the entire cost of a nursing home patient’s bill.
EB: There are 30 hospitals in the state. I think only five of those have a net margin. They're in the black. So we have some hospitals that are really, really struggling currently. In addition to that, our nursing homes have really struggled to recover since the pandemic.
NO: Would hospitals or nursing homes shut down?
KK: Boley wouldn’t go that far but says it could be a possibility. He’s really concerned about the state of healthcare in Wyoming right now. Federal dollars are drying up, and local governments face cuts to property tax revenues. He said current problems, like the state’s maternal healthcare desert, could be exacerbated by all of this.
EB: We're already struggling to provide maternal health and OB services in the state. And a large portion of the deliveries that take place in our state are Medicaid recipients.
KK: He’s also worried about automatic re-enrollment stopping. He says this could lead to fewer people having insurance.
NO: What else are healthcare folks looking at as Congress works through this budget bill?
KK: I went into this reporting just concentrating on the proposed Medicaid cuts. But almost immediately, everyone told me that I should be looking at something else that will have an even bigger impact on the state’s healthcare industry.
That was cuts to the health insurance Marketplace’s enhanced premium tax credits.
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 expansion was extended but is set to expire later this year.
About 8% of Wyomingites are enrolled in the Marketplace this year.
I spoke with Caleb Michael Smith. He’s with Enroll Wyoming, a nonprofit that helps Wyomingites navigate and sign up for marketplace insurance.
Caleb Michael Smith: 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.
NO: How do these tax credits tie in with the Big Beautiful Bill?
KK: The package wouldn't renew the enhanced premium tax credits. Michael Smith says this means the monthly cost for insurance will significantly increase.
CMS: They expect that the monthly cost will go up 194%. 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.
Editor’s Note: You can use this calculator by Kaiser Health to calculate how the expiration of enhanced subsidies in 2025 might affect your premium payments.
KK: It’s a pretty big monthly jump. Michael Smith says they [Enroll Wyoming] are estimating that up to 20,000 Wyomingites would drop from the Marketplace. That’s over half of the number who are currently enrolled. He says Enroll Wyoming will still be there to help those people who don't qualify anymore.
CMS: Those of us in the program will need to work to try to connect them with other local groups, whether that's pointing them to places where there's a sliding scale healthcare provider. Here are local soup kitchens, here are the medical supplies, lending closets. One of the challenges will be for everybody engaged in this work is that we anticipate there will be more people drawing upon a smaller pool of resources.
KK: That last point is one that everyone I spoke to mentioned.
Wyoming Hospital Association’s Eric Boley is worried that having fewer people having insurance will put a huge financial strain on hospitals and our healthcare system.
EB: It's kind of a double whammy and it'll just put additional downward pressure on the financial strength and viability of all the providers in the state.
KK: This is really on the mind of Beth Worthen. She’s the CEO of Natrona Collective Health Trust. They are a private foundation dedicated to the health and well-being of residents of Natrona County.
Beth Worthen: 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.
KK: She says all of this will likely have a longstanding negative impact on the healthcare industry. She mentioned federal grant cuts to nonprofits, state cuts to property taxes and this potential reconciliation bill.
BW: Private funders can only do so much. And so really, our assets are a drop in the bucket compared to the power that the federal and state governments can do to strengthen our communities and allow individuals to be healthier.
KK: Worthen says Wyoming is at a crossroads. And it’s worth noting Enroll Wyoming, the nonprofit Caleb Michael Smith works for, got 90% of its grant funding cut, so they will be downsizing in the next few months, potentially making it even harder for people to find the resources they need, as those resources become more and more limited.
NO: What are the next steps?
KK: The Senate is supposed to review the Big Beautiful Bill this month. It’s predicted that substantial changes will be made before the Senate passes it. There’s a self-imposed deadline to get it to President Trump’s desk by July 4.
But everyone I spoke to expressed hope that things will change and the impact won’t be as big to the state. Micheal Smith put it succinctly.
CMS: Decision makers do not fully recognize the impact it has on people's lives and what will happen when these changes happen so more discussion would be greatly helpful.
Editor’s Note: WPR will continue updating this story.
