As Wyoming residents brace for the country’s highest jump in Obamacare insurance premium costs, the Wyoming Department of Health is proposing an alternative to prevent the kind of financial ruin that can result from catastrophic illness or injury.
The proposal would establish a state-operated public benefit plan, dubbed “BearCare,” that would cover health care emergencies, such as a car crash or a bear attack, for dues-paying members.
State lawmakers, however, expressed concern over costs, sustainability and even the name of the program as the Wyoming Legislature’s Joint Appropriations Committee met Monday in Cheyenne.
“I don’t think we’re supposed to create programs that can’t be sustained,” Appropriations Committee Co-Chairman John Bear, R-Gillette, said at the meeting.
Initially, the program would rely on federal funds currently up for grabs and earmarked to transform rural health care, but it would ultimately be self-funded via members’ monthly enrollment fees. Based on the Department of Health’s description, it would be somewhat akin to private catastrophic insurance plans, where people pay low premiums for high-deductible coverage that’s useful for major health emergencies, but doesn’t cover typical care.
“We have a very unique year this year, given the opportunity from the Trump administration and Congress with the One Big, Beautiful Bill Act and the Rural Health Transformation Program funding that’s currently in process,” Department of Health Director Stefan Johansson told lawmakers Monday.
The federal program is designed to funnel $50 billion to state-designed programs meant to improve rural health care, and Wyoming stands to receive up to $800 million. The state submitted its application in November, which included BearCare in addition to plans to stabilize hospitals, bolster preventative health care, grow the workforce and use technology to improve access. The funding will be doled out over five years.
The Centers for Medicare and Medicaid Services expect to announce winners Dec. 31. In the meantime, the Department of Health is asking lawmakers to include a placeholder in the state budget bill.
“We don’t know what our ultimate award — if we get an award — from the federal government would be in that program,” Johansson said at the meeting. “So in full transparency, we wanted to bring that request for spending authority, should we be approved in that program and should the state want to accept those funds.”
The BearCare portion of the application, however, gave several committee members heartburn.
“I just don’t see how this is the proper role of government,” Rep. Ken Pendergraft, R-Sheridan, said, echoing the committee’s discussion last week regarding the Wyoming Business Council’s efforts to improve the state’s economy.
This fall, the department surveyed residents and held 11 public meetings across the state to collect input for its federal application.
“We did not hear back a wish list of all the expensive, short-term things that every community wanted,” Johansson told lawmakers. What the department heard instead included a desire for emergency services at critical access hospitals, regional access to OB-GYN and maternity care and “an ambulance that shows up relatively quick when you call 911.
“Those things that we heard, we really designed the application around,” he said.
Monday marked the second week of the committee’s budget hearings ahead of the 2026 legislative session.
Ahead of budget hearings, the Wyoming Freedom Caucus — a group of Republicans who control the House — pledged to cut the budget, citing “pre-pandemic spending levels” as a general target. And over the legislative off-season, lawmakers took extra steps to scrutinize the Department of Health’s budget by forming a subcommittee.
BearCare
While the name is a nod to “Wyoming’s deeply forested areas and bear population,” Johansson said, “it kind of hearkens back to what some people knew health insurance to be in previous decades.”
By offering small employers and individuals an affordable benefit plan that is closer in spirit to auto insurance — it covers collisions, but won’t pay for basic maintenance — the plan would provide the “bare necessities,” Johansson said.
The lawmaker who shares his last name with the program did not back the effort, suggesting two alternatives, including a different name.
“Without your objection, I’m going to call it ‘GordonCare,’” Rep. Bear said, presumably in reference to Gov. Mark Gordon, who lauded the proposal in his budget letter.
BearCare is “an innovative, but basic, health benefit plan that offers individuals and small businesses a practical alternative to costly ObamaCare insurance,” Gordon wrote.
Instead of a health benefit plan, Bear suggested the state consider tackling the problem “from the other side” by creating a “perpetuity fund” to help cover hospitals’ unpaid bills.
But that likely wouldn’t work within the confines of the Rural Health Transformation Program, Johansson said.
“In fact, a lot of the guidance from the federal government when it came specifically just to fixing or correcting balance sheets, [it] will likely not be allowable,” he said.
Rep. Bill Allemand, R-Casper, said he was concerned the program would force the state into an income tax. Johansson was clear that wouldn’t be the case.
“Mr. Chairman, Rep. Allemand, my answer would be unequivocally no,” Johansson said.
Sen. Mike Gierau, D-Jackson, was the one committee member to speak in favor of BearCare.
“I’m a small business person, so I’m kind of keen on this,” Gierau said. “What you’re trying to do isn’t trying to provide that big of a social [safety] net. You’re just trying to give a hand up to help small businesses [to] be able to handle a problem that I have to face every single day in my business.”
Gierau also said he expected to see increased interest in such a program.
“If the increases in the ACA kick in the way they’re going to kick in,” he said, “I got a hunch you may hear some more clamoring, but that’s just a guess.”
Roughly 45,000 Wyoming residents who get health insurance through the Affordable Care Act marketplace are set to experience the highest price jumps in the nation, as WyoFile previously reported. In Wyoming, a 60-year-old person earning roughly $63,000 annually could face a 421% increase in average monthly premium costs on the ACA marketplace, according to reporting by KFF, a nonprofit that writes about health care.
Budget hearings will continue through this week before resuming Jan. 5. The committee is not expected to take any formal action on the budget bill until the week of Jan. 12.
What type of ambulance calls will the fund cover, basic-advanced, non emergency- emergency? Will it cover both the hospital ER charge as well as that from the independent contractor ER physician? How may days of hospitalization will it cover? Will it cover only ground or also expensive air ambulances?
An article from 2013 that is still on point: https://time.com/198/bitter-pill-why-medical-bills-are-killing-us/
The ACA, through limiting the percentage of premiums insurers can collect for admin/profit, has the perverse effect that insurers have zero incentive to negotiate down costs. The more it costs, the more they get to keep since their overhead stays the same.
I am trying to find something exactly like what is proposed here. I can handle basic care and maintenance.
I’m young (ish), healthy. I can handle an urgent care trip. Probably even a broken bone.
What I can’t handle is $34K in premiums and deductibles annually for insurance I likely won’t use.
But I also can’t afford to not get insurance because of that one off chance I get attacked by a bear (cancer).
Wyoming has 28 hospitals (18 state/local, 5 non-profit, 5 for-profit). Like all hospitals across the nation they are concerned about the uninsured that they see daily that in turn effects their bottom dollar, but until there is the change in philosophies that would accept single payer healthcare it should not be a burden of the citizenry to bail out a business. As the mean age for Wyomingites is 39.9 and the continued drop of birth rates continues at the current pace the possibility of fewer health care facilities could also decline. Wages have been largely stagnant for most U.S. workers for decades in part due to widening income inequality which leads us to continue to kick the ball down the field until both philosophical end zones become father and father apart.
Peace all
Legislators are failing to address the root of the problem. Exorbitant medical care coverage plans are taking advantage of the middle class and lower income families because the the legislators in Washington D.C. allow it to occur. They have been bought with lobbying money. The legislators complain and argue about the Affordable Care Act as the problem as a guise to cover up the real problem, overcharging by medical care providers.
These are cost comparisons for the U.S.A., Canada, Mexico and Germany, for two of the most common surgery procedures conducted, caesarean section and hernia. Using insured/negotiated plans.
“Insured / negotiated” = the allowed/negotiated amount an in-network commercial insurer pays to the provider (often shown by FAIR Health, HCCI, etc.). That’s different from an uninsured charge and different again from what a public payer (Medicare/Canada/Germany) records as cost to the system.
Prices vary a lot by state/region, procedure complexity, length of stay, and whether the case has complications. The ranges below reflect typical in-network (insurer) allowed amounts or the usual public-payer/system cost ranges and typical private self-pay prices where appropriate.
I cite the most relevant sources after each country’s numbers.
Side-by-side summary (typical ranges / central estimates)
United States (commercially insured — in-network, “negotiated” allowed amounts)
C-section (total in-network allowed amount): median/typical ~$16,000–$19,000 (FAIR Health shows national medians in this band; state medians vary widely).
FAIR Health
+1
Hernia repair (inguinal, elective): negotiated/in-network allowed amounts commonly ~$4,000–$12,000 for routine cases; more complex or inpatient cases higher. Medicare/quality datasets and consumer sites report wide variation; some Medicare-based measures show lower hospital-claim allowed amounts (~$2k for narrow measures), but commercial in-network prices are usually in the several-thousand dollar range.
GoodRx
+1
Canada (resident covered by provincial public insurance)
Out-of-pocket for a resident with provincial coverage: $0 (hospital and physician services related to delivery and most elective hernia repairs are covered — patient pays nothing or only nominal fees where applicable). Costs are borne by the provincial health system. CIHI provides case-costing tools showing average hospital cost per case (varies by province and complexity). Typical system cost for a C-section case in CIHI/academic examples is roughly on the order of CAD ~$4,000–$8,000 per case (varies by province and complications); private-sector/non-resident charges are higher. For elective hernia repairs done within the public system, the patient typically pays nothing; system costs are commonly a few thousand CAD per case.
CIHI
+1
Mexico (private hospitals / self-pay; insurance arrangements vary)
C-section (private hospital typical self-pay price): widely reported ranges from ~USD $1,500–$8,000 depending on facility, city, package (some aggregator/clinic sites often report $2k–$8k). (If a U.S. insurer pays a Mexican provider through a specific cross-border agreement the negotiated rate will depend on that contract.)
Pacific Prime
+1
Hernia repair (private/self-pay): typical private-clinic ranges ~USD $1,500–$5,000 for routine inguinal hernia repair (open or laparoscopic), depending on surgeon, hospital, and anaesthesia/mesh used.
Hernia Specialists of Mexico
+1
Germany (statutory/publicly insured patients; DRG reimbursement system)
Patient out-of-pocket (statutory insured): typically very low or zero for the hospital bill — statutory health insurance reimburses hospital via DRG tariffs; patients pay modest co-payments for a short period or small daily fees in some cases (often a few hundred euros or less, depending on length of stay). Examples: for insured patients, C-section patient OOP is often €0–€420 reported in practical summaries; exact hospital DRG reimbursement per case (what the insurer pays the hospital) typically lies in the low thousands of euros depending on complexity (many sources/DRG tables put uncomplicated C-section and routine hernia DRG reimbursements roughly €2,500–€9,000 depending on coding/length of stay and hospital base rate). Reported mean hospital costs for routine inguinal hernia repairs in research samples are around €2,500–€4,000.
Wise
+2
German Hospital Service
+2
Short plain-English takeaways
USA: Highest insurer-negotiated prices for deliveries — typical commercial in-network allowed amounts for a C-section are often in the high-teens of thousands of dollars; hernia repairs in-network commonly run in the low-to-mid thousands but can reach >$10k for complex cases. FAIR Health and HCCI document the large state-by-state spread.
FAIR Health
+1
Canada & Germany: residents with public/statutory coverage usually do not pay (or pay only small co-payments) — the public system or statutory insurer covers the bill; the cost to the system per C-section or hernia is typically a few thousand (CAD/EUR), much lower than typical US commercial allowed amounts. CIHI and German DRG data/documentation support this.
CIHI
+1
Mexico: private/self-pay prices are materially lower than U.S. commercial prices for comparable private hospitals (hernia often a few thousand USD or less; C-section packages vary widely — many private clinics list $1.5k–$8k). Quality and what’s included in the package vary, and negotiated insurer payments (if any) depend on contractual arrangements.
Pacific Prime
+1
Important caveats (please read)
Huge local variation. Within the U.S. the difference between states and even hospitals in the same metro area can be very large — FAIR Health maps show state medians ranging widely.
FAIR Health
“Insured/negotiated” depends on the insurer and network. The numbers above for the U.S. are in-network allowed (typical negotiated) amounts — being out-of-network often means much higher billed charges.
FAIR Health
Definitions differ across sources. Some sources report hospital charges (what they bill uninsured), some report allowed amounts (what insurer actually allows/pays), some report system cost (what the hospital’s internal accounting shows). I used insurer/allowed or payer-cost figures where available and noted public-payer cost/coverage for Canada and Germany.
Amazon Web Services, Inc.
+1
An idea that is funded by people who would use it. Started with money from the Federal Government that is going to go to someone, so why not Wyoming. Has the chance to become self funded…kind of seems like something worth trying.
Freedom Caucus: No, this is a horrible idea. Let people just go to the hospital and not pay their bills and we’ll use the money to pay hospitals.
WDH: The money can’t be used for that. Do you have a better idea?
Freedom Caucus: Nope, but who cares! Let’s just not solve any problem and go with that plan anyways and let hospitals charge everyone else more money because of all the unpaid bills or better yet, close! Yeah – that’s a better idea! Bonus points because people of Wyoming get to stress and suffer over health care and emergencies which will probably make them sicker! Who needs to solve problems with you have us in control!
Uumm…these policies already exist on the ACA stupid. For zero dollars a month I can get coverage, BUT I’d better not use it because the deductible is like $15,000. Who’s got that just lying around? These ideas don’t work. America has been here before, and it sucked. Like high risk pools? Terrible idea! Republicans have zero ideas on health care period. As they’ve proven year after year after year.
I’m really beginning to wonder what Rep. Pendergraft believes the role of government is? Because twice now he has stated what it’s not (helping the states economy and providing catastrophic insurance to those that can’t afford regular health insurance), so Ken what is it than? According to his voting record government’s role is to tell women what to do with their own bodies and police which bathroom folks use. So the government is supposed to control people but not help them, is that it Ken?
Wyoming is rapidly slipping into a health care desert.
Appears to be all about money with republicans against spending anything to help this situation and the one democrat small business person in favor of, sounds like a good idea to me as when a person is badly injured with long and expensive recovery it always comes down to money in the end. I know people that were well off and then cancer strikes and with inadequate insurance it doest take to long before they are broke or bankrupt and dead so yes with a little imagination and hard work this could be a cheap way to address a serious problem in society . Sounds like the fed will provide money initially and then this type of insurance would cover it all and would survive by premiums paid by those people that desire this protection.