The interim Joint Labor, Health and Social Services committee convened over two days in Casper on June 23 and 24.
Access to maternal health care in Wyoming was an area of particular focus for the committee. Maternity deserts are defined as areas without a hospital or birth center offering obstetric care and without any obstetric physicians. Franz Fuchs with the Wyoming Department of Health testified that Wyoming has several long standing maternity deserts, like the state’s far northeast corner, Big Horn County and Sublette County. But Fuchs also expressed concern about new maternity deserts, like parts of Fremont County and Uinta County, and regions that are trending in that direction.
“These are areas of the state that previously had maternity services, but no longer do because of the closure of a hospital labor and delivery unit,” said Fuchs.
Last year, Evanston Regional Hospital ended labor and delivery services. This came after the closure of three other labor and delivery units across the state. Fuchs testified that the closures are a symptom of broader financial strain on the state’s hospitals.
“They’ll take their least profitable cost centers and start taking those offline, and labor and delivery is not a particularly profitable cost center for hospitals,” said Fuchs.
Fuchs pointed to multiple underlying causes for the strain. Wyoming has a small population, and the number of births in the state is generally declining, which means low volume for hospitals. Wyoming Medicaid’s reimbursement rates to hospitals for births are comparatively low. The average amount paid by Medicaid for a birth is $7,500. The average amount paid by private insurance is $20,000. The Wyoming Department of Health testified that roughly 30% of births in the state are covered by Medicaid.
“The hospitals are really the anchor in these communities for labor and delivery,” said Fuchs. “When a community loses its hospital, that really is the linchpin that holds it all together. And it's really hard to put it back.”
Another challenge for hospitals is recruiting medical staff. Advocates called for an expansion of graduate medical education and residency programs focused on rural health, psychiatry and obstetrics.
But some testified that Wyoming’s abortion restrictions make recruiting physicians more difficult. Britt Borrell testified as a private citizen.
“We have little hope of attracting qualified OB-GYNs to practice in our state when your colleagues are so focused on restricting abortion access that providers cannot navigate the legal landscape to provide the full standard of care to their patients,” said Borrell.
The committee explored several solutions for Wyoming’s maternity healthcare deserts. Representatives with Blue Cross Blue Shield of Wyoming announced a new maternal health program, which will work to address gaps in maternal healthcare through increased provider reimbursements for first trimester visits, free prenatal vitamins delivered by mail and support around lactation and mental health. Dr. Jacques Beveridge is an OBGYN with the Cheyenne Women’s Clinic and sits on the Governor’s Health Task Force. He shared that the University of Wyoming Family Medicine Residency Program in Cheyenne is starting a residency track focused on obstetrics.
Before the committee meets again, legislators asked to get information on mobile health units, solutions to maternity care deserts from other states, midwifery and the relationship between the COVID-19 vaccine and pregnancy.
Sen. Charles Scott (R-Casper) proposed a draft bill to raise Medicaid reimbursements for obstetric services and Rep. Joel Guggenmos (R-Riverton) proposed that a house bill from last year that added protections for pregnancy centers be revived.
Committee members also discussed challenges facing rural emergency services in Wyoming, many of which are similar to maternal healthcare.
The Wyoming Department of Health’s Fuchs testified that ambulance services experience a mismatch between fixed costs and actual revenue. According to Fuchs, roughly one third of annual ambulance calls in Wyoming are not reimbursable through insurance because a patient did not get transported to the hospital, and the volume of calls in rural areas is low. The vast majority of Wyoming’s 44 emergency services run on significant subsidies. The department estimates the gap between cost and revenue is roughly $30 million. Fuchs said subsidies can come from volunteer hours or tax dollars, but they aren’t always sustainable.
“The system has developed since the ’70s with a strong reliance on volunteers,” said Fuchs. “Volunteerism generally is declining in the United States, [and] more and more services are having to fill those positions with paid staff.”
Fuchs advocated for using state funding to transition to more sustainable subsidies, like relying on fire departments or critical access hospitals to respond to emergency calls.
Rep. Pam Thayer (R-Rawlins) proposed draft legislation around bankruptcy and hospitals and Sen. Scott proposed a draft bill around insurance reimbursements for ambulance services.
The committee will meet again in October.
