Though critics have decried President Donald Trump’s One Big Beautiful Bill Act as a means to strip Medicaid and insurance coverage from tens of thousands of Wyoming residents, supporters point to a bill provision aimed at boosting rural health care.
The Rural Health Transformation Program is designed to funnel $50 billion to stabilize and strengthen rural hospitals and providers. Wyoming, one of America’s most rural states, stands to receive $500 million to $800 million from the program over the next five years, according to the health department.
Before it applies for the money, however, the state wants to pin down Wyoming’s highest-priority needs. The Wyoming Department of Health will kick off a string of public meetings on Friday aimed at gathering input on rural health care challenges and opportunities.
Meetings begin Friday in Newcastle and wrap up Oct. 2 in Laramie. A virtual gathering is scheduled for Sept. 23.
“Local voices will guide us in identifying where investments make the most difference and how the state can play a constructive role in making the most of this unique opportunity,” Stefan Johansson, director of the Wyoming Department of Health, said in a release.
Those fighting for better health care access in Wyoming aren’t totally sold, however. The federal funds could certainly be helpful, Healthy Wyoming Executive Director Jenn Lowe said, but with a five-year time limit, they won’t likely do enough to make up for the recent and expected losses incurred in a state that already struggles with a dearth of resources.
“It sounds significant, but it really is just a drop in the bucket,” against the background of aggregate needs, Lowe said.
Still, she added, “people who care about health care access in Wyoming should absolutely go to these meetings” to help shape how those funds can be spent.
Eroding landscape
With its rural characteristics, Wyoming has long struggled to provide affordable and accessible health care. Hospitals struggle to hire and retain doctors and nurses, service lines like baby deliveries have eroded and patients travel hundreds of miles for treatment.
Several recent factors converging on both the state and federal levels further threaten access to care in Wyoming.
“Costs will go up for just about anybody who purchases insurance in the state, and access to care is likely to go down,” Lowe told an audience at a recent health care forum in Lander.
The One Big Beautiful Bill Act is projected to reduce federal Medicaid spending by $793 billion over 10 years. That will result in 10.3 million fewer people enrolled nationally, according to the Congressional Budget Office. Changes include increased work requirements and potential penalties for states that have expanded Medicaid.
As one of the few states that hasn’t expanded Medicaid, Wyoming will avoid some of the immediate hits, experts say. But it will still likely result in coverage losses as well as other downstream effects. The cuts in the federal bill could cost Wyoming nearly 200 jobs per year and shrink the state’s economy by $140 million over five years, a new economic analysis finds.
The Wyoming Medicaid program covers 62,000 patients, according to Families USA. Some 46,000 residents, meanwhile, get health insurance through the Affordable Care Act marketplace, which is available to people who don’t qualify for Medicaid and don’t have insurance through an employer.
That second patient pool is also anticipated to see major changes. Enhanced premium tax credits on the Affordable Care marketplace are set to expire at the end of 2025 — and the bill does not renew them. That will result in significant premium spikes for some patients.
According to Healthy Wyoming, a 60-year-old couple with an annual income of $82,000 will face an increase of $37,422 in annual health care costs due to the tax credit loss. The organization anticipates that the tax credit sunset puts somewhere between 11,000 to 20,000 Wyoming residents at risk of losing their coverage.
“These tax credits have been a lifeline for folks in Wyoming to afford health care insurance,” Lowe said.
A shrinking pool of insurance providers is only expected to further exacerbate the issue. Mountain Health Co-op announced in August that it will no longer offer health plans in Wyoming at the end of the year.
In addition, the nonprofit Enroll Wyoming, which offers free help to those seeking health coverage, saw a roughly 90% cut in funding in August. The organization has transitioned from a 10-person staff to 1.5 full-time employees. While much smaller, Enroll Wyoming still endeavors to assist residents, a press release stated.
A major investment
Republicans pushed back on criticism of their bill’s health care impacts, pointing to programs contained in it that they say will boost rural care.
In remarks lauding the bill’s passage, Wyoming Sen. John Barrasso, a physician, said it strengthens health care, “especially in rural communities.” He pointed to a renewed push for innovative care, hospital support and Medicaid work requirements as benefits.
“I practiced medicine in Casper, Wyoming, for over 20 years,” Barrasso said. “The changes in this law will strengthen Medicaid for the people who truly need it.”
One of the bill’s offshoots is the Rural Health Transformation Program, which will supply $50 billion to stabilize and strengthen rural hospitals and providers. Half of that money will be divided among states that submit applications. The idea is to let states determine the best use of funds.
According to the Wyoming Department of Health, program funding is intended to support priorities that include chronic disease prevention, behavioral health, access to care in rural communities, workforce development and technological advances.
In addition to the eight in-person meetings around the state, the department will collect input by sending out a survey later this fall to refine the priorities.
A healthy dose of skepticism
The program promises a significant infusion of funds into Wyoming’s health care network, and supporters say it does so with a common-sense approach.
“The [program] is designed to help all rural hospitals, not just those in states that have been gaming the system,” reads a Senate Finance Committee fact sheet. “But for the states that need help re-focusing their Medicaid programs, the RHTP can serve as a bridge to shore up rural hospitals and prevent gaps in care.”
Lowe, however, doesn’t see it as a panacea. Programs spawned from it will likely require funding beyond the five-year window, she said. And that’s not her only concern.
“I think that it’s fair to say that whenever large chunks of money like this are pumped into grant-funded programs,” Lowe said, “some of those programs prove to be successful and some might even be revolutionary in how they treat rural health care. However, there will also be boondoggles, and there will be bridges to nowhere where funding is spent and nothing ever happens.”
That’s why it’s crucial that people partake in the process now, she said.
“I think it’s imperative that people pay attention to what’s going on in Wyoming to ensure that … this money is not wasted, that it’s spent in a way that leaves a long and effective program in its place.”