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. And Donald Trump won in Wyoming in the 2016 election with more than 70 precent of the vote. But 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.
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.
Barrasso and Enzi are still in the Senate, but Liz Cheney has been Wyoming’s House Representative since 2017. Cheney is also opposed to the ACA, and voted in favor of the American Health Care Act, the House’s 2017 effort to repeal the ACA.
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. And in the summer of 2017, the Senate voted on three different versions of an ACA repeal bill — all of them failed (which is why the ACA wasn’t repealed in 2017), but Barrasso and Enzi voted in favor of all three.
Gov. Matt Mead is also 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.”
But Wyoming lawmakers have thus far rejected Mead’s calls to expand Medicaid. Instead, 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).
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 highest in the country in 2018, but that’s calculated before premium subsidies are applied. The subsidies in Wyoming are particularly large in 2018, and after the subsidies are applied, people in many areas can get bronze and even gold plans at no charge.
But for people who don’t qualify for premium subsidies, coverage is increasingly 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 HealthCare.gov, enrollment dropped in 2017, but that was not the case in Wyoming.
Enrollment in most HealthCare.gov 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.
Wyoming Medicaid/CHIP enrollment
Although Governor Mead has pushed for Medicaid expansion, Wyoming is currently one of 19 states that have not yet expanded Medicaid. This means that 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 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/CHIP enrollment in Wyoming had actually decreased by 5 percent since the end of 2013. And by January 2018, enrollment in Wyoming Medicaid/CHIP had was 13 percent lower than it had been in late 2013 (nationwide, Medicaid/CHIP enrollment has grown by 29 percent; Wyoming is the only state where it has declined). Pre-ACA, Wyoming’s average monthly Medicaid enrollment was 67,518; by January 2018, it had dropped to 58,981.
2018 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.
BCBSWY has continued to be Wyoming’s lone exchange insurer in 2018. Average pre-subsidy premiums in Wyoming are the highest in the country in 2018, at $983 per month. But that’s before premium subsidies are applied. For people who don’t qualify for premium subsidies, there is no doubt that coverage in Wyoming in 2018 is unaffordable in most cases. But for people who do qualify for premium subsidies, the situation in 2018 is generally better than it was in 2018, because premium subsidies are so much bigger. This is explained in more detail here, with examples.
Wyoming health ratings
The Commonwealth Fund’s 2017 Scorecard on State Health System Performance rated Wyoming 32nd among the 50 states and District of Columbia, down from 28th on the 2015 Scorecard. 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 Healthy Lives (18th place), including first and second place rankings for deaths from colon cancer and breast cancer. The state’s lowest marks were related to Equity, including 50th place for adults without appropriate cancer screening and young children without recommended vaccinations, as well as 49th place for adults without a routine doctor visit in the prior two years, and 47th for adults without a usual source of medical care.
Wyoming’s scorecard includes an in-depth look at how the rankings are determined.
The most recent edition of America’s Health Rankings (2017) also measured the state’s “healthiness” and ranked Wyoming number 26th of the 50 states – a big step up from 33rd in 2013, but down one place from 25th in 2015. The state was ranked 7th for the Community and Environment metric, but 48th for Policy. Wyoming is ranked number 1 for having the best air quality, but 50th in terms of occupational fatalities.
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 could obtain reasonable coverage elsewhere. This became effective December 31, 2015.
Medicare enrollment in the state of Wyoming
As of 2013, 86 percent of Wyoming’s Medicare beneficiaries were eligible due to age, and 14 percent were eligible due to a disability. 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. 33 percent of Medicare enrollees nationwide select Medicare Advantage plans, but almost all Medicare beneficiaries in Wyoming are enrolled in Original Medicare instead. 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. 61 percent of the state’s Medicare recipients have 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 healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.