Wyoming’s health care system has managed to do something no other state has matched, and the Wyoming Legislature is totally responsible for it.

Before you shout, “We’re No. 1!” and pat your lawmakers on the back, you need to know that we’re really No. 50 when it comes to providing the uninsured the chance to obtain health insurance.

Wyoming is the only state that has actually seen an increase in its uninsured population from 2013 to 2015. A new Gallup survey found Wyoming’s uninsured rate has gone up 1.6 percent. All other states and the District of Columbia have seen decreases in the number of uninsured residents since the Affordable Care Act (ACA/Obamacare) went into effect. (Read In U.S., uninsured rates continue to drop in most states.)

Even Texas — where slightly more than one-fifth of the total population still remains uninsured — managed to reduce its total uninsured overall. Ranking second to the Lone Star State in this category is Wyoming, where 18.2 percent of residents are without health insurance. On the other end of the scale is Rhode Island, where only 2.7 percent of the people don’t have health insurance.

Take that, Obamacare! Guess the Equality State showed the rest of the nation and the federal government it won’t march lockstep with any system that dares to anger conservatives by helping provide health insurance to its neediest citizens.

Not surprisingly, the seven states that had the biggest drops in their uninsured rates embraced the ACA on behalf of their citizens. They expanded the federal Medicaid program and also chose to run their own insurance exchanges or partner with the feds. The list is led by two conservative states, Arkansas and Kentucky, whose governors and lawmakers decided that rather than play political games they will actually help the working poor in their respective states.

The best improvements were seen in both conservative and liberal states. Arkansas’s rate fell 13.4 percent, while Kentucky’s decreased 11.4 percent. To put Wyoming’s sole rate increase in the U.S. into better perspective, consider that the next three states with the biggest gains — Oregon, Rhode Island and Washington — have all seen their uninsured rates shrink by more than 10 percent.

During the past three sessions, Wyoming’s Republican legislative leadership rejected all efforts to expand Medicaid to nearly 18,000 low-income childless adults, and also told the federal government to run its own health insurance marketplace in Wyoming. Some legislators claimed they were working on a state exchange and ran out of time to implement one. But they had a year to do it, which should have been enough time if the Legislature hadn’t put the whole effort on hold because it incorrectly expected the ACA to be declared unconstitutional.

Even so, ACA advocates say they are very pleased that 20,000-plus people are now eligible to buy subsidized insurance in Wyoming through Healthcare.gov. It’s a beginning, but tax credits for those who obtain health insurance through the federal market are only available to people within a certain income range. No help at all exists for the working poor — another 18,000 who would be eligible for Medicaid if the state would permit it.

Many legislators complain publicly and privately about people they consider slackers and deadbeats who would receive expanded Medicaid. They contend that the poor should have “skin in the game” and pay for the benefits, but apparently don’t realize (or care) that nearly 60 percent of the newly Medicaid-eligible do work at minimum-wage jobs. Many of the rest are too sick to work because they don’t have adequate health care. Imagine that.

“We are painfully aware that Wyoming is leaving another [18,000 low-income adults] uncovered because we won’t let them apply for Medicaid,” said Marguerite Herman, director of Healthy Wyoming, formerly known as the Wyoming Coalition for Medicaid Solutions. The group is still working on the issue, but its focus is on overall improvement in the state’s health care system.

Wyoming’s uninsured rate would have definitely gone down — which, after all, was the main goal of federal health care reform — if Medicaid had been allowed to expand here.

The White House Council on Economic Advisers is probably a pretty subversive group in the minds of far-right state legislators, but here’s its analysis of what Wyoming lost by not joining 28 other states that either expanded Medicaid or reached a deal with the feds to offer a state alternative:

  • An additional 14,000 people would have insurance coverage in 2016.
  • Improvement in physical and mental health — 2,000 people would report being in good (or better) health, and 1,000 fewer would experience symptoms of depression.
  • Two thousand fewer people would have trouble paying their bills due to medical costs.

Herman said the effects of being uninsured can be devastating. “People ignore injuries and illnesses until they land in the hospital, or they ‘manage’ chronic illnesses with episodic visits to emergency rooms,” she said. “They can’t pay their medical bills. They don’t get prescriptions filled. They miss work or lose jobs, and they can’t take care of their families.”

Let’s also not forget the Wyoming Department of Health study that predicted not expanding Medicaid will send 111 residents to premature deaths each year due to lack of health care. That’s an amazing and appalling statistic generated by our own state health experts, but you won’t hear about it during legislative debates about expansion. It should be at the forefront of every discussion on the issue.

Largely because many Republican-led states refused to give President Barack Obama a victory on health care reform, more than 9 percent of Americans of all ages still do not have health insurance. Combined, the 22 states that handled the issue the way Wyoming did will deprive 4.3 million citizens of health insurance coverage in 2016.

Republican Gov. Matt Mead initially gave mixed signals about Obamacare, calling for the creation of a state health exchange but firmly opposing Medicaid expansion. By his 2015 State of the State address to the Legislature, he told lawmakers they can’t keep throwing away more than $100 million in federal money every year and advised them they “must” expand Medicaid. His own party leaders, though, voted against the same Medicaid plan they had asked Mead and the Department of Health to devise.

Earlier this year, the conservative Wyoming Business Alliance surprised a lot of observers when it announced support for Medicaid expansion. Its president Bill Schilling told a pair of legislative committees that the high cost of health care in Wyoming is a major deterrent to attracting both labor and new businesses to the state, but his pleas were callously brushed aside. Ditto the support voiced by good-government groups, hospitals, insurance companies, church associations and municipalities. Honest assessments by respected lobbyists that it’s simply “the right thing to do” fell on deaf ears, even though these are the same people legislators are usually happy to listen to on any other subject.

“While we watch the number of uninsured people climb, Wyoming is missing out on millions of federal dollars that would maintain a healthy workforce, strengthen Wyoming’s low-income families and health care system and boost our economy,” Herman said.

However, the Healthy Wyoming director still has some optimism left four years into the fight for Medicaid expansion.

“We hope lawmakers who chose delay as a policy will take a hard look at the human and economic costs and act now,” she said. “It’s not too late.”

Herman, who has worked tirelessly in this effort, is much more diplomatic than I am. The news that Wyoming is the only state in the country that actually has more uninsured residents now than it did when the ACA went into effect isn’t surprising, given the complete disdain the vast majority of GOP legislators have shown for Medicaid expansion. However, after seeing them ignore all of the consequences of their inaction on the people they supposedly represent, it makes me angrier than ever.

Lawmakers in this state have refused to listen to every single reasonable argument about health and economic benefits, societal responsibilities to help the poor, and their own fiscal negligence in declining hundreds of millions of dollars in federal funds — taxes that Wyoming residents contributed to but may not see in return. When they make a harmful decision that literally impacts the lives of everyone in the state, I don’t give a damn if they’re offended when someone calls them on it.

Will citizens ever wake up and demand the Legislature quit treating the working poor as sub-humans who don’t deserve health care?

— Columns are the signed perspective of the author, and do not necessarily reflect the views of WyoFile’s staff, board of directors or its supporters. WyoFile welcomes guest columns and op-ed pieces from all points of view. If you’d like to write a guest column for WyoFile, please contact WyoFile editor-in-chief Dustin Bleizeffer at dustin@wyofile.com.

Kerry Drake

Veteran Wyoming journalist Kerry Drake has covered Wyoming for more than four decades, previously as a reporter and editor for the Wyoming Tribune-Eagle and Casper Star-Tribune. He lives in Cheyenne and...

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  1. This is real simple to understand, bring heath care costs in Wyoming to a reasonable level and I would have insurance, as would most other families I know.

    For a family of four with an income of 70k in Rawlins, it costs more than $1600.00 per month after the supplement. Change my zip code to Denver, CO and “WOW!” its only $230.00 per month. HMMM lets do some math. Pay one time $1400 (2% of 70k) or pay 1600 per month (over 30%) of my income to an overpriced heath insurance. Affordable is NOT part of this equation.

    Obamacare took my $400 per month policy and trashed it. per the insurance company “This policy is no longer available because of Obamacare.”

    I have a novel idea how about all insurance is the same across the nation, no matter where you live.

  2. Health insurance does not equal health care. I am so glad fewer people in Wyoming aren’t buying into the system.

    If given all my pay in cash, I would not buy anything other then a catastrophic policy with a 10k+ deductible. Anything else is a foolish waste.

    We would be way better off to pay cash directly to the provider for our healthcare needs, just as we do for automotive care, house care and every other service we use (except education of course, we definitely don’t want any competition there).

    Casey Craig

  3. Do not underestimate the vehemence the right feels for all things Obama. If Romney would have won the last election, he would have proposed Romneycare for all the states and it would have sailed through Wyoming like a greased pig at the county fair.

    Jim Phillips

  4. Kerry is right on target once again. It is the Wyoming citizens who are suffering because of politicians. While the key decisions are being made by Governor Meade and the legislature, it seems that they are following the regressive Washington “leadership” of Lummis and Barrasso. These two have made it their calling to undermine the people’s right to health care in order to advance their personal political goals.

    Wyoming deserves better and unless our Washington representatives are voted out of office or see the facts that US healthcare is outrageously expensive and only mediocre in outcomes, the US will continue to lag behind all other western countries. The citizens need to wake up to the facts and demand better leadership.

    Loren Nelson, MD

  5. Nancy,
    You are right to an extent. If an elderly/disabled person uses Medicaid to pay for nursing home care, after the patient AND spouse die they can look to the sale of the home or any assets to repay what Medicaid paid to the nursing home. They do not do the same for health care; separate issues.

    Kathy Luzmoor

  6. That last comment is typical of the debate in Wyoming and the Legislature. It’s hard to have a productive conversation when so much “information” provided in opposition to expansion is flat out wrong or is off topic. The person who says Medicaid comes for your home might be talking about Medicare, which does seek recover some costs. So it is both off topic and wrong. So is quibbling over exactly how many thousands of low-income adults in Wyoming have no health care because they cannot afford insurance.
    Focus, people.
    The fact is that Medicaid successfully and efficiently provides health coverage to low-income people in Wyoming. We could let adults without dependent children apply for that coverage, and our share of the cost would be 0-10 percent. But we just won’t, to the detriment of people, providers and our economy.

    Marguerite Herman

  7. Do all of you know the truth behind medicaid ? If you are on it and own a house or other property when you die medicaid wants paid back and they put liens on it so your relatives end up with a nightmare sorting it all out. Maybe our legislators were protecting us ???

    Nancy Appel

  8. FYI. Alaska implemented Medicaid expansion July 2015. They did do something right.
    Lucy Williamson
    Cheyenne

  9. First if the insurance costs didn’t outpace income, more people would have insurance. Plus many of us don’t want insurance!!! Cheaper to pay fine than the increases of now up to 40%. As a former member of the lovely MASS healthcare system I can tell you that next comes a choice: pay for healthcare or feed your families. Unlike before we can’t move to another state. Want to help the uninsured? Open clinics that don’t charge massively for care. Most can’t afford the $150 just to enter these clinics and as an American we pay CASH!

    Mikey Brenner
    Cheyenne

  10. Second observation: Alaska achieved an 8.6% reduction in its uninsured without expanding Medicaid or implementing a state/partnership exchange. Alaska did something right, and Wyoming legislators will be checking it out. Arkansas, on the other hand, saw a 13.4% drop, having expanded Medicaid. However, it came at such an extraordinary and unanticipated expense that Arkansas is now on a glide path to reversing the expansion. The Arkansas model was popular in 2013, but has since been thoroughly discredited as unworkable and unaffordable.

    Rep. Marti Halverson
    Etna

  11. Thank you for a great piece that paints a true picture of what has been happening with regard to the ACA, Medicaid expansion and the state legislature. We see first hand the health issues Wyoming people encounter without access to affordable health care due, in part, to lack of Medicaid expansion.

    Lucy Williamson

  12. Halverson’s response to Drake’s essay is rather oblique. Perhaps she would deign to explain what her statistics mean. Does she mean to say that Wyoming technically is not at fault for having thousands of uninsured citizens? Surely, if it can be shown that Wyoming’s legislative leadership really does care about its fellow Wyomingites, then maybe we can now wash our hands of guilt. Then, again, perhaps we don’t need a clarification of Halverson’s figures, after all. Didn’t the evangelists who helped establish Christianity say something about following the spirit, rather than the letter, of the law?

    Mark Junge

    1. Quoting Gallup’s statistics, the basis of this article. With a 4% margin of error, it could mean our uninsured numbers might have actually gone down.

      Marti Halverson

  13. First take-away: Going from 16.6% uninsured to 18.2% uninsured is within the margin of error for LARGE states (1%-2%). Margin of error for small states, such as Wyoming, is a whopping 4%. This article is baseless.

    Marti Halverson