If you live in Kemmerer and you're having a baby, you drive. Same in Rawlins, Evanston and Wheatland.
All four towns have lost labor and delivery since 2022. Nine counties have no labor and delivery services.
Eleven counties have no practicing OB/GYN.
Do we really want expectant mothers to drive eighty miles through a blizzard, in labor, to deliver a baby?
Eric Boley, CEO of the Wyoming Hospital Association, says six of our thirty hospitals are in immediate financial jeopardy and three are on the verge of closing. He said it at the Capitol during the budget session.
In June, Beth Worthen of the Natrona Collective Health Trust told a health policy summit in Laramie the same thing.
Three could go inside three years.
Nobody will name the six. I understand why.
Say out loud that a hospital is failing and you help finish the job.
The physician you were recruiting takes the other offer, and the medical equipment vendor notices.
Here is the part that ought to get everybody's attention.
This session the Legislature passed Senate File 5, letting memorial hospitals and hospital districts file for bankruptcy reorganization.
That bill was not drafted as a theoretical exercise. Somebody asked for the bill to be drafted.
The answer we keep reaching for is the Rural Health Transformation Program — as much as a billion dollars over five years, if CMS approves the state plan.
That is real money and I hope we get every dime.
But Boley spent part of the session explaining to legislators that the two things they kept mixing up are not the same thing.
Transformation dollars cannot be used to raise what a hospital gets paid for treating a patient.
Transformation dollars can buy equipment. They cannot close the payment gap, and the payment gap is what is closing the six.
Which brings us back to the argument we have been having since 2013.
About 11,000 Wyoming adults sit in the coverage gap.
They earn too little to qualify for a subsidy on the exchange and they are not eligible for our Medicaid, because we never expanded it to 138 percent of poverty.
They do not stop getting sick.
They show up in the emergency room, federal law requires the hospital to stabilize them, and the hospital writes it off.
Hospitals in Wyoming book tens of millions of dollars in uncompensated care.
Someone is already paying for the care, and that someone is us, through the taxes we pay, charity care and cost shifting charges for other services.
If we expanded Medicaid, the federal government would pay a large chunk of the uncompensated care.
The question is, are we suckers for paying the bill ourselves rather than letting the federal government pay part of the bill?
Are we foregoing care that could already be paid for?
Are we risking closure of our hospitals, degradation of quality of care and people’s health because we are afraid of a political talking point?
Expansion turns a share of those write-offs into a paying claim at ninety cents on the federal dollar.
Forty states and the District have taken the deal.
We are one of ten that have not, and our federal tax money (tax dollars we are already paying) helps Utah and North Dakota and Ohio cover theirs.
The case against expansion is not frivolous and I won't pretend it is.
If Congress ever trims that 90% match, the obligation does not disappear — it lands on our general fund, and we have all watched a federal promise get rewritten in the middle of a biennium.
The cut to 50% was proposed in 2025, and Congress declined to make it in a reconciliation bill purpose-built to cut Medicaid by half a trillion dollars.
If the expansion match were going to get gutted, that was the moment, and it didn't happen.
The concern can be addressed by putting a trigger in the enabling act, an automatic repeal if the federal share drops below 90%.
These political positions do not do is keep a small-town hospital open.
Whatever any of us thinks about the eligibility category, the uncompensated care is already being paid.
We are paying it right now, through cost shifting, at retail, with no federal match at all. We picked the most expensive way in the world to cover these folks and then told ourselves we hadn't covered them.
We need to honestly look at the risks to our healthcare system, instead of playing politics.
Is lack of medical care, closed hospitals and risks to people’s lives are worth the price of being able to say we are pure conservatives?
Tom Lubnau served in the Wyoming Legislature from 2004 to 2015 and is a former Speaker of the House. He can be reached at: YourInputAppreciated@gmail.com
