Wyomingites may be skeptical of Obamacare, but many use it for health insurance

Wyoming leaders have repeatedly rejected Medicaid expansion, but a new study shows many residents here rely on another component of the Affordable Care Act: the health insurance marketplace.

Among the 10 states with the highest share of farmers, Wyoming uses the federal health insurance marketplace the most, according to a new analysis by the Robert Wood Johnson Foundation. That marketplace is a virtual space for comparing plans and finding insurance that’s often more affordable than elsewhere thanks to federal subsidies.

More than 42,000 Wyomingites made marketplace plan selections during the 2024 open enrollment period, comprising more than 7% of the state’s population.

The analysis also showed that Wyoming benefited the most from advanced premium tax credits, bringing down the $937 average monthly market premium in the state to $118.

“Healthcare is actually more expensive in a lot of rural states than in urban states because there’s a shortage of providers,” said Katherine Hempstead, report author and senior policy advisor for the foundation, which focuses on public health and health care issues. “It’s not very competitive, there’s long distances, and Wyoming is an especially expensive state for healthcare.”

Bar chart showing the differences between average premiums before and after advanced premium tax credits
(Marketplace Pulse: Health Insurance Coverage in Farm Country, Robert Wood Johnson Foundation)

Wyoming has the nation’s third-highest average premium rates, according to the Centers for Medicare and Medicaid services

Premium costs vary by zip code and personal situation, but these tax credits are often crucial for Wyoming families, says Caleb Smith with Enroll Wyoming — a free tool to help people navigate the marketplace.

“They’re a make or break for most people,” Smith said.

According to the analysis, 95% of people using the marketplace in Wyoming receive those tax credits. Others may have just not filled out paperwork or might not qualify.

Without being renewed, the tax credits will expire in 2026. And without the credits, self-employed groups like farmers could have a harder time affording health care, Hempstead said, and being uninsured in a higher-risk profession could be costly.

Stigma

While tens of thousands of Wyomingites utilize the marketplace, there’s still stigma associated with it. The marketplace was created via the Affordable Care Act, often called Obamacare. The name, alone, can be polarizing in conservative Wyoming.

But there’s also concern over seeming like you need help, Smith said.

“Some people still see it as a stigma to be using these programs, even if it means improving the quality of care,” he said. “That’s not just the marketplace, I’ve worked with our local soup kitchen, and I know people who would rather go hungry than be seen in person at the soup kitchen.”

The marketplace is primarily for helping people look through health insurance options at a time when costs have ballooned nationwide. That may include people who are self-employed, working jobs that don’t provide insurance and those who don’t qualify for Medicaid.

Smith and Enroll Wyoming work with people to help them navigate the marketplace and other insurance options in Wyoming. And while most people sign up during open enrollment — from November through mid-January — Smith said there are many qualifying reasons to sign up at other times.

That could include, “having a new kid in the house, maybe adopted, maybe you’re taking care of foster children,” he said. “That might be you got married, you got divorced, the person who was providing health insurance is no longer providing health insurance.”

Still, after passage of the Affordable Care Act, opposition in Wyoming was clear. One UW election survey conducted last decade found that about three-quarters of residents disapproved of the law.

Lawmakers then worked to change the state constitution in response to the outcry. The language voters later approved states: “Each competent adult shall have the right to make his or her own health care decisions.”

That wording has become a key legal argument against Wyoming’s two abortion bans, which are currently tied up in district court in Teton County.

Medicaid

The Robert Wood Johnson analysis also showed that Wyoming had the lowest rate of Medicaid use among the 10 farm states with about 73,000 — or 12.6% of the state — using it.

Both Wyoming and Kansas on this list have not passed Medicaid expansion.

A spreadsheet showing marketplace and medicaid enrollment among states with high rates of farmers
(Marketplace Pulse: Health Insurance Coverage in Farm Country, Robert Wood Johnson Foundation)

Wyoming is one of 10 states that haven’t passed Medicaid expansion, which faces strong opposition from the right. After several failed attempts, many suspect it will never happen here, but still hope for some way to cover more people who fall into a gap: making too much to qualify for Medicaid but not enough to afford marketplace insurance plans.

The state estimates that expanding Medicaid could cover about 19,000 more residents over two years.

Meantime, about 17,600 Wyoming enrollees of Medicaid and Kid Care CHIP lost coverage over the last year as the state reevaluated who qualified. That’s following a several-year hiatus from the reviews during the pandemic.

Some people lose coverage when their income increases, but most are children whose guardians didn’t turn in the necessary paperwork.

Enroll Wyoming has been working with the health department to get the word out about the Medicaid renewal process, but Smith said it could be hard: many who signed up for Medicaid or Kid Care during the pandemic have never gone through this before.

“They didn’t even know that it’s an annual thing,” he said. “Or some of those people had moved in that time, and so they didn’t know that they needed to update their contact information.”

Since the “unwinding” of Medicaid began last April, Smith has also seen more people reaching out to Enroll Wyoming for help finding insurance coverage. It’s something he encourages others to do because it can be risky to go without — especially preventative care.

“The main thing is that we just want people to get health coverage so they can take care of their health, so they can have long happy lives with their friends and family,” he said.

Nearly one in four adults disenrolled from Medicaid in the last year are now uninsured, according to a KFF survey.

Those who have lost coverage for procedural reasons during this last year’s process have 90 days to provide necessary information and regain backdated coverage.

Individuals who have already received their renewal notices can update their contact information and renew coverage at www.wesystem.wyo.gov or by calling 1-855-294-2127.