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Wyoming health insurance

Wyoming has not embraced the ACA, and has rejected federal funding to expand Medicaid. The result is a higher-than-average uninsured rate

Health insurance in Wyoming

State legislative efforts to preserve or strengthen provisions of the Affordable Care Act

Wyoming is one of the states that has done the least to preserve the Affordable Care Act’s provisions.

Wyoming tends to be more conservative and hasn’t embraced the Affordable Care Act – opting for a federally facilitated exchange and refusing to expand Medicaid.

But outgoing Governor Matt Mead, a Republican, has pushed for Medicaid expansion for several years, and regrets the fact that the state still hasn’t expanded Medicaid — a decision that has cost Wyoming $577 million in missed federal funding.

The Wyoming health marketplace

Wyoming does not run its own health insurance exchange, so residents enroll in coverage using Open enrollment for 2019 coverage ended on December 15, 2018. Enrollment is still open for Wyoming residents who have qualifying events.

2019 rates and plans

As has been the case since 2015, Blue Cross Blue Shield of Wyoming is the only insurer offering plans in the state’s health insurance exchange. But average premiums for 2019 are decreasing slightly in Wyoming for 2019 — in contrast with 2018, when premiums rose by an average of 48 percent and Wyoming ended up with the second-highest pre-subsidy rates in the country.

Average benchmark premiums in Wyoming are unchanged for 2019. Premium subsidies are based on the cost of benchmark plans, so subsidies will be fairly consistent from 2018 to 2019 (changes in income or plan selection will alter the subsidy amounts, as will the fact that the percentage of income that people have to pay for the benchmark plan has increased slightly for 2019).

Subsidies are particularly large in Wyoming, since premiums are so high. For people who don’t qualify for premium subsidies but whose income is just a little over the subsidy-eligibility cut off, there is no doubt that coverage in Wyoming is unaffordable in most cases. But for people who do qualify for premium subsidies, coverage can be a bargain. This is explained in more detail here, with examples.

Wyoming is considering a reinsurance program as an option for stabilizing the individual market and reducing premiums. Several other states have implemented reinsurance programs in 2017 and 2018; most have seen significant premium decreases as a result.

AlaskaSouth CarolinaDelaware, Mississippi, and Nebraska also have just one insurer offering coverage in the exchange for 2019, although two insurers are now offering coverage in the exchange in Iowa and Alabama, where there was only a single insurer in each state in 2018.

Wyoming and the Affordable Care Act

Wyoming’s U.S. congressional delegation is comprised entirely of Republicans: Senators Mike Enzi and John Barrasso, and Representative Liz Cheney. All three are opposed to the ACA.

In 2017, Cheney voted in favor of the American Health Care Act, which was House Republicans’ effort to repeal the ACA. Barrasso and Enzi both voted in favor of all three pieces of legislation that GOP senators introduced in an effort to pass ACA repeal in that chamber. None of those bills was successful, however, and the ACA remained in place. Although opposition to the ACA has been a mainstay for Republicans in Congress, Barrasso and Enzi have been even more opposed than most. In October 2014, they were among 14 senators who called for an opposition to spending related to the temporary risk corridor program that was built into the ACA in an effort to stabilize the individual markets.

Cheney and Barrasso both won re-election in 2018, and both have been elevated to the third-highest-ranking positions for Republicans in their respective chambers. Cheney has been picked to be the House GOP Conference Chair, and Barrasso is the new Chair of the Republican Conference in the Senate.

Outgoing Governor Matt Mead has also been generally opposed to the ACA, but he has been in favor of Medicaid expansion since 2013, after initially opposing it before that, when states were first considering expansion. 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.”

Mead was term-limited and did not run again in 2018. But Governor-elect Mark Gordon, also a Republican, is opposed to Medicaid expansion — a position that he continues to hold, despite the fact that three neighboring states (Idaho, Nebraska, and Utah) passed ballot measures to expand Medicaid in the 2018 election. His Democratic opponent, Mary Throne, supported Medicaid expansion, but Gordon won by a very wide margin.

Regardless of the governor’s position, Wyoming lawmakers have thus far rejected Mead’s calls to expand Medicaid. And the overwhelming Republican majority in the state’s legislature makes that position unlikely to change in the near future. Instead of expanding Medicaid, Wyoming’s Senate passed a work requirement for Medicaid in 2018, which would have been applicable to the currently-eligible Medicaid population (which does not include non-disabled adults without dependent children). A House committee killed the measure, however, so it did not move forward in the 2018 session.

How did Obamacare help Wyoming residents?

Wyoming is the least populated and the second-least densely populated state, both of which contribute to higher-than-average health insurance premiums. According to US Census data, the uninsured rate in Wyoming was 13.4 percent in 2013, which was lower than the 14.5 percent national average at that point. But by 2016, Wyoming had the seventh-highest uninsured rate in the country, at 11.5 percent (versus the national average of 8.6 percent in 2016). And by 2017, the uninsured rate in Wyoming had climbed to 12.3 percent (the national uninsured rate also climbed a little in 2017, but only to 8.7 percent). So as of 2017, Wyoming had the sixth-highest uninsured rate in the country.

Wyoming’s decision not to accept federal funding to expand Medicaid is largely to blame for the smaller-than-average reduction in the uninsured rate. An estimated 20,000 people would become eligible for Medicaid if the state were to expand coverage. That’s nearly 3.5 percent of the state’s population, and would make a considerable dent in the uninsured rate.

Average individual market health insurance premiums in Wyoming are the second-highest in the country in 2018, but that’s calculated before premium subsidies are applied. The subsidies in Wyoming are particularly large due to the high premiums, and after the subsidies are applied, people in many areas can get bronze and even gold plans at no charge.

But for some people who don’t qualify for premium subsidies, coverage can be unaffordable in Wyoming. Subsidies are not available to people in the coverage gap (which would be eliminated if Wyoming were to accept federal funding to expand Medicaid), people impacted by the family glitch, and people who earn more than 400 percent of the poverty level.

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, with 23,770 people purchasing coverage. 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.

For 2017, enrollment in Wyoming’s exchange grew again, with 24,826 people selecting plans. In most states that use, enrollment dropped in 2017, but that was not the case in Wyoming.

Enrollment in most states dropped again in 2018, by an average of 5 percent. But while enrollment in Wyoming’s exchange did drop slightly from 2017 to 2018, it was only about a 1 percent decline, with 24,529 people enrolling. Effectuated enrollment as of early 2018 stood at 23,089.

Short-term health plans in Wyoming

Wyoming defaults to the federal limits for the duration of short-term plans. The Trump Administration relaxed those rules in 2018, so short-term plans in Wyoming can have initial terms of up to 364 days, and total duration, including renewals, of up to three years.

Learn more about the rules for short-term health plans in Wyoming.

Wyoming Medicaid/CHIP enrollment

Although outgoing Governor Mead has pushed for Medicaid expansion, Wyoming is currently one of 14 states that have not yet expanded Medicaid [Technically there are still 19 states that haven’t expanded Medicaid as of November 2018, but Virginia’s Medicaid expansion takes effect January 2019 (enrollment began in November 2018), and Maine, Utah, Nebraska, and Idaho are all expected to expand Medicaid in 2019 as a result of ballot initiatives passed by voters.]

Because Wyoming has not expanded Medicaid (and is thus missing out on hundreds of millions of dollars in federal funding) the state has 6,000 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. In all, about 20,000 people would become newly-eligible for Medicaid if the state were to expand coverage, including people with income between 100 percent and 138 percent of the poverty level, who are currently eligible for premium subsidies in the exchange.

But 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 doesn’t exceed 54 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 of June 2016, average monthly Medicaid/CHIP enrollment in Wyoming had actually decreased by 5 percent since the end of 2013. And by August 2018, enrollment in Wyoming Medicaid/CHIP had was 14 percent lower than it had been in late 2013 (nationwide, Medicaid/CHIP enrollment has grown by 27 percent; Wyoming and Oklahoma are the only states where it has declined, and Oklahoma’s decline was only 1 percent). Pre-ACA, Wyoming’s average monthly Medicaid/CHIP enrollment was 67,518; by August 2018, it had dropped to 57,969.

More information on Wyoming’s Medicaid and CHIP coverage and eligibility is available here.

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 could obtain reasonable coverage elsewhere. This became effective December 31, 2015.

But Governor-elect Mark Gordon has floated the possibility of returning to a high-risk pool model, and the issue could be considered by lawmakers during the 2019 session. High-risk pools in most states were underfunded and generally insufficient in the years prior to the ACA; a substantial amount of money has to be made available to a high-risk pool for it to function well. Reinsurance programs (sometimes called “invisible high-risk pools” are a more sustainable idea, and Wyoming is also considering that possibility.

Medicare enrollment in Wyoming

Wyoming Medicare enrollment reached 106,787 in November 2018. That’s a little more than 18 percent of the state’s overall population – and fairly similar to the percentage of the U.S. population enrolled in Medicare.

As of 2016, 87 percent of Wyoming’s Medicare beneficiaries were eligible due to age, and 13 percent were eligible due to a disability. Nationally, the ratio is 84 percent aged to 16 percent disabled.

For Original Medicare enrollees in Wyoming, Medicare spent an average of $7,681 per enrollee in 2016, which was among the nation’s lowest. The national average was $9,533 in per-enrollee spending. Wyoming’s cost per enrollee was 19 percent lower than the national average, and Wyoming was one of just eight states with per-enrollee costs under $8,000 in 2016.

Nationwide, about 36 percent of Medicare enrollees are in Medicare Advantage plans (or Medicare Cost plans). But in Wyoming, only about 3 percent of Medicare enrollees select private Medicare Advantage plans instead of traditional Medicare. This is due in large part to the fact that Medicare Advantage plans simply aren’t available in most of Wyoming.

Wyoming’s Medicare beneficiaries may also select stand-alone prescription drug coverage in the form of Medicare Part D. Of Wyoming Medicare recipients, 61 percent have stand-alone Part D coverage compared with 45 percent nationwide.

The high percentage of Medicare enrollees with separate Part D coverage is directly related to the low enrollment in Medicare Advantage and the high enrollment in Original Medicare in the state, since Part D plans are designed to be used in conjunction with Original Medicare. (Most Medicare Advantage plans include built-in Part D coverage.)

State-based health reform legislation

The Wyoming Senate passed SF97 in 2018, which would have imposed a Medicaid work requirement. The House did not pass the measure.

Scroll to the bottom of the page for a summary of other recent Wyoming bills related to healthcare reform.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.