Wyomingites brace for spiking health insurance prices as marketplace changes loom

Lately, budget planning has been a source of uncertainty and dread for Laramie resident Jessica Brauer.

The executive director of the Laramie Plains Civic Center gets her health insurance through the Health Insurance Marketplace, which was created under the Affordable Care Act in 2010 to help more Americans afford coverage.

A prominent feature of the program, known as the Advance Premium Tax Credits, provides subsidies that drastically reduce premium costs. With the credits, Brauer pays around $325 a month. Without them, she said, her monthly costs would be $816 — a 150% jump.

She has been lucky to be generally healthy, she said; she hasn't needed extensive or expensive care. She carries the policy more for the off chance that something catastrophic were to happen.

But now Brauer — one of more than 40,000 Wyoming residents who are covered on the marketplace — is wondering if she'll be able to afford insurance without the tax credits. Congress has not extended them beyond 2025, meaning they will expire after December unless federal lawmakers take action.

Because of the way enrollment works, Brauer and others don't know how much the costs will change.

"That's the part that is the most unsettling … I don't totally know until the marketplace opens on Nov. 1" what the cost breakdown will be, Brauer said. "So I'm in kind of an odd holding pattern, where I am waiting for the marketplace to open and then I'll know what my options are. I'll then know if they work with my budget or not."

In addition, Brauer was covered through Mountain Health Co-op, which announced in August that it will no longer offer health plans in Wyoming at the end of the year. That means Wyoming will be down to just two providers.

If she does face costs in that $800-monthly range, Brauer said, she'll likely find another option.

"Frankly, I don't think I would be able to pay it," she said. "That is comparable to my mortgage payment."

The end of the tax credits will have significant implications on the health care access of thousands of small business employees, self-employed individuals and others in Wyoming, advocates warn. Between 11,000-20,000 state residents are at risk of losing their coverage due to the anticipated cost increases, according to Healthy Wyoming.

"These tax credits have been a lifeline for folks in Wyoming to afford health care insurance," Healthy Wyoming Executive Director Jenn Lowe said.

While patients like Bauer are bracing for significant — and in some cases untenable — increases, advocates worry that too many others aren't aware of what's about to happen.

The change comes amid several recent developments expected to further diminish care in Wyoming, a state that has long struggled to provide health care access.

Mounting challenges

Wyoming's rural nature creates many challenges to health care access. Hospitals here struggle to hire and retain doctors and nurses, services like baby deliveries have eroded and patients increasingly travel long distances for specialists and other health services.

The One Big Beautiful Bill Act, passed in July, 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 42,000 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.

In 2020, Congress created the enhanced tax credit to overcome affordability challenges. That helped contribute to an all-time low in America's uninsured rate, health advocates say. Congress extended the credits in 2022 and must act again to make them permanent before they expire at the end of the year.

Time is running short; there are about 30 days until enrollment opens.

"Because [Wyoming is] a big rural state, health care costs are already higher," said Thea Zajac, senior director of grassroots advocacy for Blood Cancer United, a national nonprofit that fights to cure blood cancers and improve the quality of life for patients and families. "The premiums in these plans tend to be higher in states like Wyoming and Alaska, and so the jumps for folks in the state are going to be even more dramatic" than in more populous states.

The estimated impacts look alarming for some. 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 because of the tax credit loss.

It's been difficult to spread the message to the public, Lowe and Zajac said. Insurance is complicated, and it's likely many people who receive the credits aren't even aware of that fact. Both expect that many people will go to sign up for the marketplace and be shocked at the new rates.

"I think there's a lot of people who have these plans who are just going to be blindsided by this," Zajac said.

"I honestly feel like, I would say more than half will probably just decline to even buy insurance," Lowe said.

In a development that could bolster health care here, Wyoming stands to receive $500 million to $800 million from a new federal program, the Rural Health Transformation Program, which aims to stabilize and strengthen rural hospitals and providers. But critics are skeptical that short-term funding boosts can create sustainable solutions.

Looming deadline

Lander resident Elizabeth Aranow and her husband, both independent contractors, are insured through the marketplace. They are also contending with huge unknowns when it comes to the costs of health care coverage.

If the tax credits aren't renewed, Aranow said, monthly costs could be "hundreds, if not thousands of dollars more," she said. "But we just don't know."

It's created a new layer of stress in their lives, she said, and fueled questions like: "Do I need more contracts? Do I need to stop doing contract work and find an employer that offers health insurance?

"And so it's, it's unsettling to have such a big financial question," Aranow said. Not having insurance isn't an option, she added. "I want to be responsible and I want to financially plan, but I can't financially plan for something I don't know what it is. And I think that that makes it even harder."

Congress can still act. Ideally, the body would pass an extension as part of the continuing resolution that needs to pass by Sept. 30 to fund the federal government, Zajac said.

"We're at the last kind of possible point to really fix this before people are now going to start getting their renewal notices," she said. "The deadline is looming."

Wyoming's congressional delegation supported the Big Beautiful Bill. Wyoming Sen. John Barrasso, a physician, said the new Rural Health Transformation program the bill created will ensure continued health care access in the state.

"It will give Wyoming's rural providers the resources to adopt innovative technologies, expand access to care, and retain highly skilled healthcare professionals," Barrasso wrote in a Sept. 26 newsletter.

Wyoming's health department is currently holding public meetings around the state aimed at gathering input on rural health care challenges and opportunities.