When I first heard about the Legislature kicking the tires last year on a state vehicle to offer catastrophic health insurance to Wyomingites who have been priced out of the market, I had some hope for the proposal.
Opinion
I admit that hopeful part didn’t sound like me when the topic is what the state is willing to do to lower healthcare costs. After rejecting Medicaid expansion for 14 years, to the point where no one will even mention it at the Capitol, it inspires zero confidence in legislative leadership.
Still, I know that it’s imperative for Wyoming to search for solutions to the healthcare affordability and access problems of people who, through no fault of their own, lost coverage.
I’m talking about the more than 9,000 state residents who saw their premiums on the federal Health Insurance Marketplace jump at the highest rate in the nation this year after Congress in late 2025 refused to extend enhanced premium tax credits that had kept Affordable Care Act premiums low.
Some Wyoming families were hit with premiums that increased more than 400%, and they decided to take the risky but fiscally understandable move to go without any health insurance coverage at all.
The Wyoming Department of Health recommended creating a catastrophic insurance program called BearCare. It would at least provide coverage for extremely expensive healthcare problems that can bankrupt people, like being injured in a car accident or attacked by a bear.
BearCare was originally part of Wyoming’s application for Rural Health Transformation funding passed by Congress as part of President Donald Trump’s so-called “One Big Beautiful Bill” that also provided huge tax breaks for the wealthy.
But the far-right Freedom Caucus, which controlled the state House, balked at BearCare because it contended state government should not be running any healthcare program, and it objected to its reliance on federal funds.
Before the 2026 session ended, the Legislative Management Council appointed the Wyoming Health Insurance Affordability Task Force that was tasked during the interim to study proposals to reduce healthcare costs. Its mission was given funding for one year.
The task force included legislators, hospitals, medical associations, insurance companies and the health department. It decided to further investigate whether BearCare could help reduce Wyoming health insurance costs for residents and also keep hospitals from absorbing uncompensated care costs when patients didn’t have catastrophic coverage.
But last week the task force, at its final meeting, decided not to advance BearCare. After extensive study, Legislative Service Office Attorney Anna Johnson said the program’s premiums “would probably actually have to be fairly high to cover everybody in the pool,” so any cost savings wouldn’t have been as high as previously hoped.
The task force also nixed another leftover proposal from this year’s budget session to create a state-administered division to negotiate, purchase and distribute medical devices to participating healthcare facilities in an attempt to reduce costs through coordinated purchasing.
After doing its due diligence on both proposals over several months and reaching the same conclusion, the task force explored some other creative ideas.
One of the most intriguing is another proposed by the health department. It’s not a finished product, and I have reservations about some pieces of this complex puzzle, but it would seem to have the potential to provide some significant health cost savings.
Wyoming would create a list of expensive, yet-to-be-determined “core” health services and reduce what individuals are charged for them. The state would use a block grant to help cover hospitals’ costs.
By regulating those core services under a public utility-like commission, health department officials believe the cost of premiums will decrease while procedures that people can shop for would be more affected by the free market.
Franz Fuchs, deputy director of the health department, said because the state would be severing its ties to core services, insurers may not be required to have those core services offered in-network.
“You let those insurers have more free reign in terms of negotiating prices and steering patients and sending patients to the most-cost effective places for care,” Fuchs said. “So you’re essentially unchaining the free market to do what it does best, which is drive, you know, hopefully innovation and drive costs down.”
Phrases like “essentially unchaining the free market” don’t give me any comfort at all, because it doesn’t automatically ensure a positive result no matter how hard the speaker hopes it will.
The amount of money the state may have to spend on the block grant also gives me heartburn. Depending on rates paid by insurers and other payers, the plan could require Wyoming to pay between $100 million to $350 million annually.
That’s a wide gap and some very serious money. And given the Legislature’s disdain for any kind of taxes, I don’t think Fuchs’ remark that the money could be generated by a premium tax or a payroll tax on large corporations, plus using state investment income, is likely to result in its favorable consideration.
But there are aspects of this proposal that deserve to be studied. Payers — whether self-pay, private insurance, Medicaid, Medicare or employer plans — would all be charged the same amount for the core services.
Billing would be consolidated to one state-administered clearinghouse. The rate for the core services would be between 100% and 200% of the Medicare rate, which Fuchs pointed out is significantly less than what private insurers are usually billed for.
Before it ended its work for the year, the task force approved a motion to ask the Legislative Management Council for a second year of funding for another round of work to consider the core services package and other ideas.
In general, I’m not a big fan of multi-year interim studies, but when it comes to making healthcare more available and affordable, Wyoming needs to be all in.
Wyoming can make strides to improve rural healthcare through the millions of dollars in federal funds the state will receive over the next decade under the Rural Healthcare Transformation plan. But we have so many health-related problems to fix that there’s no need to limit whoever is involved.
Whether it’s a single lawmaker, a committee, a caucus or a coffee klatch, good ideas can come from anybody. We need to have people available to listen and make good informed judgments about whether any of these concepts will work. The legislative task force didn’t approve the pair it was handed, but studying them and concluding neither was up to snuff was valuable work.
There will be other ideas for the task force to explore after the 2027 session. BearCare may not have made the grade, but a different catastrophic health insurance plan might work. And how about a serious look at Medicaid expansion?
One thing is clear: It would be a mistake to tell task force members to fold their cards and go home.
