Wyoming's catastrophic 'BearCare' health insurance plan could become reality

Wyomingites may soon be able to enroll in "BearCare," a proposed health insurance plan designed to cover people injured in catastrophic emergencies like bear attacks.

On Monday, the federal Centers for Medicare and Medicaid Services awarded Wyoming $205 million to strengthen rural health care in the Equality State.

The Department of Health included BearCare in its application for the funds. Given that the federal government did not require the state to remove it, officials took the award notice as a green light.

"Our understanding is that our application has been approved in its entirety, to include "BearCare," Lindsay Mills, a Wyoming Department of Health spokesperson, wrote in a statement.

BearCare now appears to be headed to the Wyoming Legislature, which will be tasked with setting up a statutory framework for the health insurance plan and allocating federal dollars. If approved by the Legislature, BearCare could offer an alternative for people recently faced with skyrocketing health insurance premiums on marketplace plans offered under the Affordable Care Act, also known as "Obamacare."

The skyrocketing premiums were caused by Congressional lawmakers' decision to not extend key Obamacare subsidies. That means BearCare may use federal dollars to address the fallout from the federal government's move.

The federal money was awarded as part of the $50 billion Rural Health Transformation Program, put forth in July's Trump-backed "One Big Beautiful Bill Act." Wyoming's award was the second highest in the nation on a per-capita basis, trailing only Alaska, which received $272 million.

The Wyoming Department of Health floated BearCare after learning that people in the state thought health insurance was unaffordable. BearCare, they say, would only cover unforeseeable emergencies. The plan would thus be cheaper for members on a per-month basis, since BearCare wouldn't pay for routine care.

Getting attacked by a bear in Wyoming's wilderness could constitute an emergency, officials said, part of the reason the plan was dubbed "BearCare." The name was also a play on the 1967 Jungle Book song "The Bare Necessities."

"It's really just the bare bones of what's required for an emergency, or follow-up care after that bear attack," Franz Fuchs, the department's deputy director, told the News&Guide in November.

The proposal appears to be unprecedented.

Michelle Long, a senior policy manager at KFF — a health research, policy and news organization — said she had never heard of a state proposing a similar plan.

To Long, BearCare seemed like a fixed indemnity plan, a sort of insurance that covers limited health care and is not required to follow federal health insurance requirements dictated by the Affordable Care Act. Those requirements include covering 10 essential health benefits — including doctors' services, inpatient and outpatient hospital care, prescription drugs and more. Under the Affordable Care Act, health insurers also cannot deny coverage to people who have pre-existing conditions.

"It provides a fixed dollar amount for certain medical care," Long said. "At the federal level, [it] wouldn't be required to follow those ACA rules."

Fixed indemnity plans, more generally, are part of a "Wild West" of health coverage options that people are turning to as Obamacare marketplace health insurance becomes more expensive for many Americans.

"I think it may have a benefit for a few people," said Jen Davis, the director of the Wyoming Primary Care Association. "I don't think it solves our problem with marketplace subsidies going away. It certainly does not improve access to primary care."

A large portion of health care spending goes toward treating chronic disease, Davis said, adding that primary care could help prevent people from developing conditions like diabetes. BearCare would not cover primary care, which concerned Davis.

"I prefer, in my scheme of things, to look at a more proactive approach instead of a reactive approach," Davis said.

Some state lawmakers have questioned how much BearCare would cost. The program would make up only a small portion of the $205 million award, officials said. And though federal funds would help set up BearCare, members' monthly fees would cover health care fees thereafter. That means the program will not rely on government subsidies in the long term, Mills said.

"BearCare may offer meaningful relief to people priced out of insurance, but it is a very small piece of the overall Rural Health Transformation plan," Mills said.

The other federal funds in Wyoming's Rural Health Transformation Program award would largely go towards efforts to improve rural hospital sustainability in the Equality State, scale up recruitment for the state's health care workforce and expand behavioral health care, Mills said.