• ‘Big Beautiful Bill’ didn’t extend subsidies that have kept insurance affordable.

 

By Alex Viveros
Jackson Hole News&Guide
Via- Wyoming News Exchange

JACKSON — Health insurance premiums could soon skyrocket for many people in Teton County and across Wyoming.

People in Wyoming who buy health insurance through the Health Insurance Marketplace, which was created by the Affordable Care Act under former President Obama, could expect to pay an average of $1,860 more in premiums every year. Prices of some Wyomingites’ health insurance premiums may more than quintuple.

The reason for the steep increase? A subsidy that has made marketplace health care more affordable since 2022 is set to expire at the end of the year.

Congress could have extended this insurance subsidy in the Trump-backed “One Big Beautiful Bill” — but did not, experts said.

“I think a lot of people don’t even realize they’re receiving this benefit,” said Jenn Lowe, the interim executive director of Healthy Wyoming, a coalition that has advocated for Medicaid expansion. “Open enrollment is going to be a big slap in the face for folks in Wyoming that are purchasing their insurance in the marketplace.”

The changes could have an outsized impact in Teton County, where about 15% of people get health insurance via the marketplace — about double the percentage in Wyoming and the U.S.

Some of the projected marketplace premium increases in Wyoming are staggering.

A 45 year-old in Wyoming who makes $62,000 a year is currently expected to pay around $5,270 a year for health insurance on the marketplace. That number could more than double to $11,680 a year, according to the Center on Budget and Policy Priorities, which is based in Washington D.C.

A key Jackson Hole health care provider worries that the dramatic rise in premiums may cause people, particularly the valley’s relatively large swath of young, healthy people, to forego health purchasing insurance entirely. That could lead to a challenging financial scenario for both patients and hospitals who may be left on the hook for pricey medical procedures.

“The worst case scenario is that they just decide not to take up any form of insurance,” St. John’s Health CEO Jeff Sollis said.

In that scenario, the hospital may not get paid if an uninsured patient needed an expensive procedure like a surgery, he said. The hospital’s budget is already stressed by underpayments.

“That’s thousands of dollars that historically we would have been paid, and moving forward we won’t get anything for,” he said.

 

‘Big Beautiful Bill’

President Donald Trump signed Congress’ budget reconciliation bill, the “One Big Beautiful Bill Act,” into law on the Fourth of July. From a healthcare perspective, the most headline-grabbing feature of the bill was its sweeping cuts to Medicaid, the federal program that provides health insurance for the lowest income Americans.

Republicans like Sen. John Barrasso, R-Wyo., touted the bill’s insurance changes as a success.

“Republicans strengthened health care, especially in rural communities. Our law puts in place important reforms to strengthen Medicaid,” Barrasso said. “As a result of Wyoming being good stewards of taxpayer funding, the changes are unlikely to negatively impact our state. Wyoming’s policies are already aligned with these reforms.”

The One Big Beautiful Bill’s proposed changes are aimed at slashing Medicaid enrollment and costs in the 40 states that had expanded the program to cover more people over the last eleven years. Wyoming is one of 10 states that had opted not to expand Medicaid. 

That means the Equality State will likely be less affected by the new law’s provisions than Medicaid expansion states, including nearby Idaho. 

Research released last week, however, suggests that Medicaid cuts could nevertheless shrink Wyoming’s economy by $130 million over five years.

Many questions remain about the direct effects of the “One Big Beautiful Bill” on health care in Wyoming. Stakeholders wonder how $50 billion allocated to support rural hospitals may make its way to Wyoming. Of that, $500 million should go to Wyoming hospitals, according to Barrasso.

“It’s good that it’s in there, and I hope Wyoming sees its fair share, so that we can put it to good use,” said Josh Hannes, vice president of the Wyoming Hospital Association. “But no details exist for how any of it’s going to work.”

Wyomingites may feel the biggest financial hit when they try to purchase health insurance on the Health Insurance Marketplace, healthcare.gov, later this year. The “enhanced premium tax credit,” which made health insurance more affordable for people who don’t qualify for Medicaid but may otherwise struggle to afford insurance, is set to expire at the end of the year.

“This is an underappreciated part of what’s going to happen,” said Timothy McBride, a health policy analyst and economist at Washington University in St. Louis. “They could have acted and extended those subsidies, but they chose not to. In fact, they’re going to make it harder to sign up for marketplace plans.”

 

Premium subsidies

Wyoming has some of the strictest eligibility requirements for Medicaid in the country, as well as some of the highest health insurance premiums. Many residents rely on the Health Insurance Marketplace to give them access to private health insurance plans at a more affordable price.

The Health Insurance Marketplace was set up by the Affordable Care Act, colloquially referred to as Obamacare. Tax credits have made premiums for health insurance plans on the marketplace more affordable since its inception. In 2021, the American Rescue Plan Act enhanced, or bolstered, those tax credits to make the health care plans cheaper. The Inflation Reduction Act, passed in 2022, extended the tax credits through 2025.

People on Obamacare plans have two options for paying premiums. They can pay upfront in full and then receive the credit back come tax time, which can be expensive. They can also opt for an advanced credit, wherein the federal government pays health insurance companies directly, lowering monthly premium costs.

The enhanced subsidy created under the Biden administration has been credited with increasing enrollment in the Health Insurance Marketplace over the last five years. Since 2020, the number of people who receive health insurance through a marketplace plan has more than doubled in the United States.

A similar trend took place in Wyoming. While 2020 saw 24,574 people enrolled in a marketplace health plan, that number has risen to 46,643 in 2025.

Although the relative increase was smaller during that time period in Teton County, roughly 15% of Jackson Hole residents obtain health insurance through the marketplace, according to data provided by the U.S. Centers for Medicare & Medicaid Services and U.S. Census data. That’s more than double the percentage using marketplace coverage in Wyoming and the United States.

Experts said it isn’t surprising that many people in Jackson Hole get their health insurance on the marketplace. Many seasonal jobs in Teton County do not offer health insurance coverage, leaving people on their own to obtain it. Servers, gardeners, cleaners, fishing guides, and other employees whose workplaces don’t offer employer-provided plans often default to Obamacare plans.

“The marketplace is an attractive option for people who are seasonal workers,” said Jennifer Sullivan, the director of health coverage access at the nonpartisan Center on Budget and Policy Priorities.

 

Possible premium rise

Barring speedy action on Congress’ part, the “enhanced” portion of the premium tax credit is set to expire at the end of 2025, which is why the hypothetical 45 year-old Wyomingite who makes $62,000 a year could see their Obamacare premium costs more than double from $5,270 to $11,680 a year.

The projections are even more dire for a 60 year-old couple in Wyoming earning $82,000 a year. The couple, too young to qualify for the federal Medicare program, are currently expected to pay $6,970 a year for marketplace health insurance. The couple could expect to pay $44,392 a year, or about $3,700 a month, following the expiration of the enhanced premium tax credit.

The impacts may vary based on someone’s age, income and more. A calculator provided by KFF allows people to estimate how much their premiums might go up. Experts are recommending that people with marketplace insurance keep a close eye on their costs this year — and be careful about automatic re-enrollment in a marketplace plan.

“We really don’t want people to do that, because they can get some real sticker shock that they are going to be very unhappy about,” said Sullivan, from the Center on Budget and Policy Priorities.