Republican nominee (now president-elect) Donald Trump won in Wyoming, a state that tends to be more conservative and one that hasn’t embraced the Affordable Care Act (opting for a federally facilitated exchange and refusing to expand Medicaid). With Republicans in control of both the Congress and the White House, will the state take steps to blunt ACA’s impact?
Wyoming and the Affordable Care Act
In 2010, Wyoming’s U.S. Senators, John Barrasso and Mike Enzi, both voted against the ACA. Cynthia Lummis, Wyoming’s single member of the House, also voted no. All three are still in Congress. In October 2014, Barrasso and Enzi were among 14 senators who are calling for an opposition to spending related to the risk corridor program that’s built into the ACA.
Gov. Matt Mead is also opposed to the ACA, but he is considering possible ways that Wyoming might be able to implement a state-based approach to Medicaid expansion under the ACA. Mead has said that although he continues to believe the ACA is bad for Americans, “there is no approach that will extricate us from the ACA. It is upon us and we must act.”
How did Obamacare help Wyoming residents?
Wyoming is the least populated and the second-least densely populated state. It is also among the 10 states with the highest percentage of uninsured residents. Yet, the state has seen increased enrollment in exchange plans with 22,076 people enrolled in individual market coverage as of March 2016, up from 18,228 the previous year.
Since the Affordable Care Act was implemented, Wyoming has seen the nation’s fourth smallest reduction in percentage of uninsured. That’s not because its uninsured rate was already low, as has been the case for other states with small reductions. Wyoming’s decision not to accept federal funding and expand Medicaid is largely to blame.
Pre-ACA, Wyoming’s uninsured rate was 16.6 percent, according to Gallup data. By the end of the 2014, the first year in which the Obamacare individual mandate was in effect and health insurance subsidies became available, that number had dropped to 12.4 percent.
However, in 2015, Gallup showed Wyoming’s uninsured rate actually increased above pre-ACA levels to 18.2 percent, making it the only state whose uninsured rate was growing. By late-2015, the rate decreased, once again, this time to 14 percent.
Wyoming enrollment in qualified health plans
In November 2013, the Kaiser Family Foundation estimated that the potential market for Wyoming’s exchange was 80,000 residents and that 47,000 of them would qualify for premium subsidies to lower the cost of their coverage. By mid-April 2014, when the first open enrollment period ended, 11,970 people had finalized their enrollment in qualified health plans (QHPs) through the exchange, and HHS reported that 93 percent of them received subsidies to lower their premiums – the second highest percentage in the country. Nationwide, an average of 87 percent of enrollees received premium subsidies.
In 2015, the number of exchange enrollees almost doubled to 21,092. From 2015 to 2016, enrollment grew in all but one county in Wyoming. By March 31, 2016, effectuated enrollment through the Wyoming exchange stood at 22,076 people. Of these enrollees, 92 percent were receiving subsidies that averaged $459 per month.
Open enrollment for 2017 coverage begins November 1, 2016, and runs through January 1, 2017.
Wyoming Medicaid/CHIP enrollment
Although Governor Mead is reportedly considering options for Medicaid expansion, Wyoming is currently one of 19 states that has not yet expanded Medicaid. This means that the state has 11,000 people in the coverage gap, with no access to financial assistance with their health insurance. They would be eligible for Medicaid if Wyoming were to accept federal funds to expand coverage under the ACA.
But for now, there is no financial assistance available for people with incomes below the poverty level who do not qualify for Medicaid under the state’s existing guidelines (Medicaid is not available in Wyoming for non-disabled adults without dependent children, and is only available for parents of dependent children if their household income is under 56 percent of poverty).
The ACA would have provided Medicaid for all Wyoming residents with incomes up to 138 percent of poverty, but a Supreme Court ruling in 2012 allowed states to opt out of Medicaid expansion, which Wyoming has done. As a result, only 2,216 Wyoming residents had enrolled in Medicaid through the exchange by mid-April 2014, qualifying under the existing guidelines.
As of June 2016, average monthly Medicaid in Wyoming had actually decreased by 5 percent. Pre-ACA, Wyoming’s average monthly Medicaid enrollment was 67,518; by June 2016, it had dropped to 64,048.
Changes ahead: 2017 rates, carriers
In 2016, Wyoming was among the states with the nation’s highest premiums and was the only state to have just one carrier on its exchange: Blue Cross Blue Shield of Wyoming.
In 2017, BCBS of WY will continue to be the state’s only exchange carrier; however, Wyoming will not be the only state with a single carrier. Alaska’s exchange will also have plans from just one carrier.
For 2017, Blue Cross Blue Shield of Wyoming proposed an increase of 7.4 percent for its individual market plans. This is the second-lowest filed average increase. Nationwide, rates increased an average of 25 percent.
Wyoming health ratings
The Commonwealth Fund’s Scorecard on State Health System Performance 2015 rated Wyoming 28th among the 50 states and District of Columbia. Wyoming’s score was determined by rankings in five categories: Access, Prevention & Treatment, Avoidable Hospital Use & Costs, Healthy Lives, and Equity.
The state earned its highest marks for Avoidable Hospital Use & Costs, including a fifth place ranking for total Medicare reimbursements per enrollee. Its lowest marks were related to Access, including a higher than average percentages of at-risk adults who went without a routine doctor visit in the past two years, uninsured rates, and individuals under age 65 whose out-of-pocket medical costs were high relative to their household income.
Wyoming’s scorecard includes an in-depth look at how the rankings are determined.
The most recent edition of America’s Health Rankings (2015) also measured the state’s “healthiness” and ranked Wyoming number 25th of the 50 states – a big step up from 33rd in 2013. The state performed among the top 20 for 16 measures, including public health funding, disparity in health status, and preventable hospitalizations. Some of Wyoming’s public health challenges include lack of health insurance and access to dentists and primary care physicians.
For more details on overall public health in Wyoming, check out the 2016 listing of Key Health Data About Wyoming, compiled by Trust for America’s Health. Interested in how your county ranks? Check out health rankings for Wyoming counties, from the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin.
Does Wyoming have a high-risk pool?
Before the ACA, individual health insurance was underwritten in nearly every state, including Wyoming, which meant that pre-existing conditions could prevent a person from obtaining a policy, or could result in significantly higher premiums or policy exclusions.
The Wyoming Health Insurance Pool (WHIP) was created in 1990 to give people an alternative if they were unable to obtain individual health insurance because of their medical history.
Now that all health insurance plans are guaranteed issue, high-risk pools largely obsolete. During the 2015 Wyoming Legislature, SF0064 was passed, allowing the Commissioner to dis-enroll risk-pool members who can obtain reasonable coverage elsewhere. This became effective December 31, 2015.
Medicare enrollment in the state of Wyoming
As of 2013, Wyoming’s distribution of Medicare beneficiaries by eligibility was as follows: 86 percent aged and and 14 percent disabled. The national distribution is 84 percent aged and 16 percent disabled.
Wyoming’s annual per-enrollee spending is $7,009, which is among the nation’s lowest. As of 2009, the state ranked 50th for overall spending with $639 million per year.
Medicare Advantage plans are available as an alternative to Original Medicare. These plans offer some additional benefits, and about 3 percent of Wyoming Medicare enrollees select them over traditional Medicare. Thirty-one percent of Medicare enrollees nationwide select Medicare Advantage plans.
Wyoming’s Medicare beneficiaries may also select stand-alone prescription drug coverage in the form of Medicare Part D. Sixty percent of the state’s Medicare recipients have Part D coverage compared with 45 percent nationwide.
State-based health reform legislation
Here’s a summary of recent Wyoming bills related to healthcare reform:
- Gov. Mead renewed a push for Medicaid expansion in Wyoming during the fall of 2015. Two versions of Mead’s budget will be presented to lawmakers by December 1. Hospitals in the state are supporting these efforts.
Other state-level health reform legislation: