State’s hospitals further strained by recent legislation

Already struggling to attract providers and care for an aging population, the state’s hospitals face even more serious headwinds in the future due to recent state and federal legislation, a leading industry official said during a visit to Big Horn County last week.

Eric Boley, president of the Wyoming Hospital Association, spent about an hour talking to a group of approximately 40 area residents and heath care workers Thursday night at Three Rivers Health.

The state has seen just one hospital closure in the past 30 years, that being in Lusk, but several have reportedly been on the brink, Boley said. A recent study showed just five of the 30 being in the black. Of those in the red, seven were in jeopardy of immediate closure and four had less than four days of cash on hand, with Rawlins being down to a day or two.

Nineteen of the state’s hospitals, including Three Rivers Health, are considered critical access hospitals. As such, they are designed to receive federal funding, primarily through Medicare Part A.

Boley described in detail the challenges facing healthcare on multiple fronts, citing the fact that it is the second most highly regulated industry in the country, the new leadership at the Centers for Medicare and Medicaid Services (Dr. Mehmet Oz) and Centers for Disease Control and Prevention (Robert F. Kennedy Jr.) and a continuous string of executive orders from President Donald Trump that keep everyone on their heels.

State tax cut

At the state level, Boley voiced concerns about the impact of property tax reform legislation passed last session. Lawmakers have already cut property taxes by 25% and are expected to consider another 25% cut in the next session, he said.

“Our critical access hospitals rely on that tax revenue to keep their doors open. ... Some only exist because of their ability to levy mills,” Boley said.

A little over a year ago, Three Rivers Health was among the state’s floundering facilities with less than 10 days of cash on hand at one point.

“We were like Rawlins,” said CEO Joel Jackson.

 Since then, the hospital district has turned the corner.

“Six of the last eight months, we’ve made money, ... and we haven’t touched the money from property taxes in two years,” said Jackson, noting that the balance of board-designated accounts has grown to $1.2 million. But TRH has also identified about $1.8 million in equipment needs and has a depreciation schedule of $1.3 million per year. 

“We have to have the ability to eventually borrow or generate enough revenue to replace that,” he said.

‘Big Beautiful Bill’

Boley detailed several ways in which the state’s healthcare facilities would be impacted by the “Big Beautiful Bill” federal lawmakers passed in early July.

“Wyoming is one of 10 states that didn’t expand Medicaid,” said Boley. “We had an opportunity to do that, and we left over a billion dollars that could have come into our state on the table. But on the flipside, we may end up looking like geniuses because those states that did (expand Medicaid) are going to take a beating (from the Big Beautiful Bill).”

While some states have a 30/70 split in money spent and money that comes back on Medicaid services, Wyoming’s ratio is 50/50, the lowest in the country.

Boley sounded an alarm over what’s transpiring in the insurance industry — and specifically, what it means to the approximately 46,000 state residents who signed up for insurance through the exchange provided by the Affordable Care Act.

Mountain Health Co-Op recently told its members that it would not cover Wyoming residents after this year, leaving just Blue Cross Blue Shield, “the 1,000-pound gorilla,” and United Healthcare, which came in a year ago offering plans on the exchange.

“In the bill that was passed, there are tax credits or subsidies paid to help insurance companies make up what they need in premiums to allow the bronze, silver and gold plans on the exchange,” said Boley. “Those enhanced premiums expire at the end of the year.

“If Congress doesn’t work on that, it will collapse the insurance exchange. We expect to see a 200% increase in premiums for those on the exchange. Even without that happening, we expect a 20 to 30 percent increase.”

Boley said healthcare costs in Wyoming are higher than other states because it has a very sparse population and cannot build economies of scale. 

“We have fixed costs in small facilities like this one,” he said. “We have to be prepared for the what ifs. If someone walks in the door, we’re expected to take care of them, but if we can’t spread the expense across a large group of people, it costs each of us more money. But the alternative is no health care in our communities.”

Boley urged residents to contact their federal lawmakers and urge them to extend the premium credits that would continue to support the healthcare exchange.

“I’m super concerned about what may or may not happen (with the exchange),” he said. “If you think about 46,000 people suddenly becoming uninsured, they are still going to come to ERs for care, or they will get super sick before coming to hospitals and will cost even more. Hopefully Congress will act.”

One aspect of the Big Beautiful Bill that could be a positive is a $50 billion stabilization fund, intended to transform health care in rural communities across the nation. The money sunsets in five years, however.

Wyoming’s healthcare facilities can apply for up to $100 million in the first year. Boley said additional money is available from the CRS, which could push the state’s total to $125 million. But he emphasized that it could not be used on capital construction and must instead be earmarked for “transforming” rural healthcare systems.

Moving forward

Boley said he is aware of “difficult conversations” taking place across the state right now involving hospital CEOs and boards centered on what services they can continue to provide and those that may have to be cut amid all the state and federal changes.

He isn’t optimistic about convincing the state legislature, which has shifted further right in recent years.

“We used to have the ability to have open dialogue where we worked on solutions together,” he said. “It’s not the same anymore.

“It’s more and more difficult for us as an organization to provide education and educate elected officials who need to be educated. We have a difficult time doing that. What we have to say is heavily discounted.”

He urged attendees to share their views with their lawmakers and to hold them to account.

Jackson’s focus was closer to home, telling attendees that critical access hospitals like TRH cannot afford a “disconnect” with the communities it serves.

“I need you to do two things: One, come here if you need care. If you had a bad experience in the past, tell me about it and maybe give us a second chance. And two, tell your friends and neighbors, every time.”

What’s true in all walks of business, Jackson said, is also true in healthcare. 

“If you stop using a service, it will go away.”