If you live in Wyoming, or you’re considering living there, you’re probably interested in issues that impact the state’s residents. There are numerous factors that might affect your own perception of the state’s attitudes toward providing health coverage and healthcare.
For starters, Wyoming has been largely resistant to healthcare reform, which has negatively impacted the state’s uninsured rate. However, the Cowboy State has seen some improvements in terms of the overall health of its residents.
We’ve put together a list of resources to help you get a clearer picture of the overall public health and attitudes towards reform in Wyoming.
Wyoming health ratings
The Commonwealth Fund’s Scorecard on State Health System Performance 2014 rated Wyoming 29th among the 50 states and District of Columbia – up one place from 30th in 2009. Wyoming’s Scorecard includes details on how the rankings are determined.
The most recent edition of America’s Health Rankings (2014) also measured the state’s “healthiness” and ranked Wyoming number 25th of the 50 states – a big step up from 33rd in 2013 thanks in part to decreased smoking, obesity and infant mortality. Wyoming’s health strengths include low rates of air pollution and violent crime, as well as few children in poverty. The state struggles with high occupational fatalities, limited availability of primary care physicians and a high prevalence of low birthweight.
For more details on overall public health in Wyoming, check out the 2015 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.
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?
Before the ACA was implemented, the uninsured rate in Wyoming 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 is growing. Wyoming’s decision not to accept federal funding and expand Medicaid is largely to blame.
Wyoming’s uninsured rate was in the middle of the pack prior to 2014, but it now is the second highest in the nation. Although Texas has more uninsured residents than Wyoming, the Lone Star State has seen a 27 percent decrease.
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. However, as happens in every state, some people dropped their coverage. By June 30, there were 18,065 Wyoming residents enrolled in QHPs. Of them, 92.2 percent were in plans with advanced premium tax credits and 51.7 percent were receiving cost-sharing subsidies.
Wyoming’s exchange had two carriers, Blue Cross Blue Shield of Wyoming, and WINhealth Partners. However, in October 2015, WINhealth announced that it would exit the individual market at year-end. That means Wyoming residents who shop the state’s federally facilitated exchange will choose from 2016 plans offered by a single carrier.
In past years, Wyoming’s rates have been significantly higher than in most other parts of the United States. Excluding Natrona and Laramie counties (Casper and Cheyenne), the state of Wyoming is the sixth most expensive region in the US for individual health insurance premiums.
For the 2016 coverage period, Wyoming’s sole exchange carrier, Blue Cross Blue Shield of Wyoming, proposed a rate hike of less than 10 percent.
Wyoming Medicaid/CHIP enrollment
Although Governor Mead is reportedly considering options for Medicaid expansion, Wyoming is currently one of 20 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 July 2015, average monthly Medicaid in Wyoming had decreased by 5 percent.
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. But WHIP is still operational. WHIP can be reached at 800-442-2376.
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.
Medicare enrollment in the state of Wyoming
Wyoming Medicare enrollment reached 94,498 in 2015, which accounts for 16 percent of the state’s overall population. Nationwide, 17 percent of the U.S. population is enrolled in Medicare. Historically, 85 percent of Wyoming Medicare recipients are eligible due to age alone and the remaining balance qualifies due to a disability.
Medicare spends about $8,165 annually per Wyoming enrollee, and the state’s overall spending ranks 50th 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-two 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. Fifty-nine percent of the state’s Medicare recipients have Part D coverage compared with 43 percent nationwide.