according to acasignups.net<\/a>, which specializes in following health\u00a0care data related to the Affordable Care Act.<\/p>\nMountain Health Co-Op had been looking at a 32% increase, according to the site, before pulling out of Wyoming.<\/p>\n
Mountain Health CEO Blair Fjeseth told Cowboy State Daily Thursday morning that several things contributed to the insurer\u2019s decision to leave the state, but the high cost of health care in Wyoming was right at the top.<\/p>\n
\u201cWyoming is one of the highest cost of care states,\u201d she said. \u201cAnd so that\u2019s created uncertainty. As a nonprofit, we operate with very slim margins, and so, the combination of truly high cost of care, the unique challenges of serving rural and frontier communities, and then the changing federal rules around APTC (Advanced Premium Tax Credit) make it really difficult to remain.\u201d<\/p>\n
The APTC was a tax credit to lower out-of-pocket costs of health care coverage on Affordable Care Act health care exchanges, to make the plans more affordable. They are set to expire at the end of the year.<\/p>\n
\u201cThose were extended and expanded during (the) COVID (19 Pandemic), and they sunset at the end of this year,\u201d Fjeseth said. \u201cAnd I know there was a push on the federal level to keep them but they were not voted to extend. Across the country, that has led to increased rates and we believe, as does the rest of the industry, that a lot of people are going to lose health care and health coverage because of it.\u201d<\/p>\n
Why Smaller Population Leads To Higher Cost<\/p>\n
The rural nature\u00a0of much of Wyoming contributes\u00a0to\u00a0the\u00a0high cost\u00a0of\u00a0insureing people.\u00a0<\/p>\n
Health care companies, like any company, can lower prices when there\u2019s\u00a0economy of scale,\u00a0because they\u2019re spreading the cost of overhead for a system around to more people.\u00a0<\/p>\n
Wyoming is the least populated state in the nation, a place where cattle outnumber people two to one, according to National Beef Wire, which has calculated cattle vs human population by state.\u00a0<\/p>\n
With fewer people to share the burden of overhead for medical care facilities, it means every individual has to pay more to help keep the lights on, over and above whatever\u00a0their\u00a0procedures cost.\u00a0<\/p>\n
An unfavorable economy of scale is not the only thing that makes Wyoming\u2019s health care market challenging, according to Wyoming Department of Insurance Deputy Commissioner Tana Howard.<\/p>\n
\u201cThere are a lot of factors that play into the market,\u201d she told Cowboy State Daily. \u201cOur rural nature and the access to care, the number of providers in Wyoming, the overall cost of health care, the health conditions of Wyoming citizens, and, in addition,\u00a0that we are an aging population. Take all of those and add state and federal law changes. There\u2019s a lot of uncertainty in the health insurance market throughout the country.\u201d<\/p>\n
The changes at the federal level have been significant, Howard added.<\/p>\n
\u201cInsurers do not know how these changes are going to affect them,\u201d she said. \u201cWe are hearing from multiple states that insurers are pulling out or making additional rate changes from plan year 2026.\u201d<\/p>\n
In fact, Mountain Health Co-Op has proposed a 25% jump on its health care exchange plans in Montana for 2026, according to\u00a0a\u00a0report from\u00a0the\u00a0Montana Free\u00a0Press.\u00a0<\/p>\n
Not Ruling Out An Eventual Return<\/p>\n
The loss of an insurer on the health care exchange does mean less competition in Wyoming, both Howard and Fjeseth said.\u00a0<\/p>\n
\u201cCompetition is good,\u201d Fjeseth said. \u201cIt draws down prices and we need that. So losing another carrier in Wyoming is not great. It\u2019s not ideal.\u201d<\/p>\n
Wyoming has been a great market for Mountain Health, Fjeseth said, and the company would like to return to the Cowboy State at some point.\u00a0<\/p>\n
\u201cI\u2019m not just saying this to say it,\u201d she said. \u201cBut I\u2019ve never encountered more gracious, kind, giving, charitable people in my\u00a0life than I have in our years in Wyoming, from just brokers who have worked to expand our network for this and man, our members are just incredible people. And I would also just say the Department of Insurance, they\u2019re protecting consumers. I believe they have the consumers in mind with every decision they make.\u201d<\/p>\n
Fjeseth has already had some preliminary conversations with Wyoming officials who have reached out to her, asking what they could do to win the company back.\u00a0<\/p>\n
\u201cWe\u2019ve had some great conversations with different parties around the state about how we can help to improve Wyoming\u2019s landscape in the health care space,\u201d she said. \u201cSo, I wouldn\u2019t count us out forever, but definitely for the next couple years while we regroup and rebuild and figure out what changes are being made in the marketplace and how we can adapt to those.\u201d<\/p>\n
More About Those Federal Changes<\/p>\n
Many of the changes at the federal level that Fjeseth referenced are coming out of the One Big Beautiful Bill Act, which\u00a0President\u00a0Donald\u00a0Trump signed into law on July 4, including the\u00a0expiration of\u00a0health-care exchange subsidies and new Marketplace rules.\u00a0<\/p>\n
The Congressional Budget Office has estimated the number of uninsured people will rise by 1.8 million by year 2034. About half of those are related to impacts of the legislation, according to the CBO.<\/p>\n
The Kaiser Family Foundation Health News, an independent, nonprofit focused on health policy research, has estimated that 17 million people will lose their health insurance in the next decade or so due to the changes in the OBBBA.\u00a0<\/p>\n
Other key changes made by the bill:<\/p>\n
\u2022 Shortens the open enrollment period by a month<\/p>\n
\u2022 Eliminates the year-round special enrollment period for those with incomes up to 150% of poverty.\u00a0<\/p>\n
\u2022 Adds a new $5 monthly charge for enrollees who fail to verify ongoing eligibility for subsidized plans.\u00a0<\/p>\n
\u2022 Adds additional documentation requirements for incomes when applying for premium tax credit.\u00a0<\/p>\n
\u2022 Disqualifies Deferred Action for Childhood Arrivals (DACA)recipients from ACA Marketplace coverage by excluding them from the definition of \u201clawfully present.\u201d<\/p>\n
\u2022 Requires repayment of any excess tax credits, in cases where enrollees\u2019 incomes were different than originally estimated.\u00a0<\/p>\n
\u2022 Requires pre-enrollment verification for income, immigration status, health coverage status, place of residence, family size, and any other information deemed necessary by the Secretary of Health and Human Services.\u00a0<\/p>\n
Wyomingites Still Have Options<\/p>\n
Insurance is a giant game of risk, one that insurers play with caution. Given that, Howard believes that eventually, as the marketplace digests all of the changes, insurers like Mountain Health Co-Op may return to Wyoming.\u00a0<\/p>\n
\u201cPrior to these recent federal changes, Wyoming had been seeing significant growth in marketplace enrollment,\u201d she said.\u00a0\u00a0\u201cMarketplace enrollment has almost doubled in the last five years.\u201d<\/p>\n
Changes have created risks, however, that insurers are still working to understand, she added.<\/p>\n
\u201cOnce insurers have a better idea of how these changes will affect Wyoming, and they have a better idea of what they are dealing with, we think they will be more likely to enter or re-enter the market,\u201d she said.<\/p>\n
In the meantime, Howard wants consumers to know that they do have options.\u00a0<\/p>\n
\u201cWe still have two insurers on the marketplace, and hundreds of licensed insurance companies that sell various health insurance products in our state,\u201d she said. \u201cOf course we hope for more competition and growth in the future, but it\u2019s important for Wyoming citizens to know qualified health plans are available in Wyoming.\u201d<\/p>\n
Shopping around and getting quotes from multiple insurers helps ensure the best deal, she added.<\/p>\n
\u201cThe DOI has health insurance shopping tools and guidance documents on its webpage,\u201d she said. \u201cAlthough the DOI can\u2019t recommend an insurer or plan, we can answer any questions consumers may have about insurance. Insurance is complicated, and DOI is here to help. Consumers can call or email any time.\u201d<\/p>\n
Wyoming Insurance Commissioner Jeff Rude, who was traveling on Thursday, told Cowboy State Daily his office will do everything it can to help consumers find new plans.<\/p>\n
\u201cWe are disappointed that Mountain Health Co-Op is leaving the Wyoming market,\u201d he said. \u201c(We) will do everything we can to assist consumers in finding appropriate coverage during this difficult time. We are standing by to answer any questions consumers may have.\u201d<\/p>\n
Solving The Rural Health care Equation<\/p>\n
Fjeseth said Mountain Health Co-Op will continue to have a footprint in its original location, Montana, as well as a continued, small footprint in Idaho.<\/p>\n
Both are states where she acknowledged the company faces many of the same challenges that they face in Wyoming, like smaller populations spread out over wider geographic areas.<\/p>\n
\u201cThose struggles are not unique to Wyoming,\u201d she said. \u201cIt\u2019s something other frontier communities are facing. How do we tackle the challenge of few people over large geographical distances? How do we serve them in the best way? That\u2019s the question I\u2019m constantly trying to figure out the solution for.\u201d<\/p>\n
It\u2019s something she believes may require a more national response than state by state by state.<\/p>\n
\u201cWe as a country, we need to come together,\u201d she said. \u201cAnd, in my opinion only, oftentimes, we\u2019re making big decisions on our industry\u00a0and\u00a0regulations, and we forget the frontier in rural health communities. But that is such a key part of the fabric of this country, and we just have to do better. We have to all come together and figure out how we can serve people and communities in deeper, more meaningful ways.\u201d<\/p>\n
Health care, she added, might be one of those areas where it shouldn\u2019t just be about the bottom line.<\/p>\n
\u201cI\u2019m biased, because I\u2019m from a nonprofit company,\u201d she said. \u201cBut I hope that as a country we can stop looking at people just as dollars and cents when they\u2019re sick, and I kind of think, \u2018Shame on us.\u2019<\/p>\n
\u201cI think\u00a0we\u00a0need to look at people like how we would take care of our moms and our dads and our siblings,\u201d she continued. \u201cAnd I think the nonprofit model works better for that, because you\u2019re mission-driven versus profit-driven. When profits are driving decisions, people are ultimately left out and impacted in negative ways.\u201d<\/p>\n
\u00a0<\/p>\n
Ren\u00e9e Jean can be reached at renee@cowboystatedaily.com<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"The health care landscape in Wyoming just became a little bit rockier with the announcement that one of…\n","protected":false},"author":2,"featured_media":83980,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[59],"tags":[97,252,253],"class_list":["post-83979","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health-care","tag-health","tag-health-care","tag-healthcare"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/83979","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/comments?post=83979"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/83979\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media\/83980"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media?parent=83979"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/categories?post=83979"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/tags?post=83979"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}