Since entering public office in 2023, Teton County Rep. Liz Storer has worked to curb the side effects of her district’s vast wealth disparities, often through targeted tax initiatives.
The Democrat said President Donald Trump’s recently signed Big Beautiful Bill Act will compound statewide property tax cuts and make that goal much harder.
“Teton County already has this record-setting inequality,” Storer said. “This bill is just going to exacerbate that.”
In a county where at least 15% are uninsured, Storer worries that existing healthcare inequality will become even more pronounced.
By giving wealthier tax brackets the biggest breaks, less affluent people will pay more for services, Storer added.
Bill backers tout its potential for debt relief, but the Congressional Budget Office says it will instead add $3.4 trillion to the national debt over the next decade. In that same timeframe, 10 million Americans are expected to lose health insurance.
Those who do retain coverage should expect to see a large surge in Affordable Care Act insurance premiums, upwards of a 200% increase. That’s because those enhanced premium tax deductions are set to expire in 2025 and the bill could have — but did not — extend them.
More than 40,000 Wyomingites get health insurance through the Affordable Care Act’s Health Insurance Marketplace, according to the Centers for Medicare & Medicaid Services. That’s where those who don’t qualify for Medicaid, or can’t get coverage through work, can purchase more affordable private insurance plans.
At least a quarter of those on the exchange could lose coverage with the bill, according to Wyoming Hospitals Association President Eric Boley.
“That’s really concerning because then they’ll be caught in that cliff where there’s no coverage at all, or they can’t afford it,” Boley said.
Ahead of Trump’s bill, the situation was already dire for several rural hospitals in Wyoming. Some only have about 10 days worth of cash on hand, Boley said. The added pressure, in large part, stems from voters approving large property tax cuts last fall, an important source of revenue for hospitals in the Cowboy State.
Legislators have recently added the possibility of another 25% property tax reduction in 2026. If approved, it wouldn’t just be disastrous for some hospitals.
“It could be the death knell for some of our hospitals and other providers in the state,” Boley said.
Another top concern for Boley is the shrunken retroactive payment period for Medicaid eligibility. What used to be a 90-day window has now been ratcheted down to 60.
“If we see delays from the state in qualifying individuals to receive Medicaid for an extended period of time, we’ll have folks that either don’t receive care or are receiving uncompensated care,” Boley said, adding that this would particularly apply to long-term care facilities and nursing homes.
There’s also the addition of work requirements for those on Medicaid, which Boley anticipates will have less of an impact in Wyoming because it never adopted the Obama-era Medicaid expansion. Those already on Medicaid won’t see as much of a change as in other states, he said.
In a last minute effort, Congress added a “rural health” fund to offset strain for hospitals in less populated parts of the country.
The $50 billion in funding could likely offset a third of the estimated cuts to federal Medicaid spending in rural areas, according to an analysis by the Kaiser Family Foundation.
However, KFF said that figure doesn’t factor in the other losses anticipated from the expiration of premium tax credits or cuts to the Marketplace.
Boley said the rural health fund could be a silver lining of sorts, but the “devil’s in the detail.” How useful it will be depends on the stipulations that come with requesting and distributing the funds, a process that is still in the works.
In general, since the state never expanded healthcare, Wyoming has a lot less to lose than other states with the passage of Trump’s bill.
On the flip side, by never expanding, Boley said Wyoming missed out in other ways.
“If we had expanded Medicaid, we would have covered a whole lot of lives and given them health insurance for more than a decade,” Boley said. “There would have been over a billion dollars that would have come into the state through expansion.”
