Health care is unaffordable for many in Wyoming. A new group would look for solutions.

In 1993, Wyoming leaders created a commission to make recommendations for reforming the state’s health care system. One out of every four Wyomingites at the time spent more than 20% of their income on medical expenses.

“Wyoming’s greatest natural resource is our people,” Thomas Stroock, a U.S. ambassador and Republican state politician who chaired the committee said that year. “Caring for their health is essential to the future of our state.”

A decade later, the state empanelled another commission to grapple with many of the same questions over health care affordability. And yet cost and accessibility remain vexing issues here, experts in the field say.

That reality is spurring state officials to take another crack at the problem with a new commission. But this one, unlike the previous iterations, would be permanent: the Wyoming Healthcare Authority.

“If you don’t have health care in an area, it’s really hard to have economic development and stability.”

Jen Davis, Governor’s Health and Human Services Policy Director

As proposed, that authority would be made of experts from the public and private sectors who aggregate data and real-world experiences to make recommendations on how to improve the state’s health care system. And unlike the previous panels, this group would stick around to see them through.

“They put the recommendations forward, but then they ended,” Jen Davis, Gov. Mark Gordon’s health and human services policy director, said of the previous attempts. “So then there was no continued conversation after that to make sure that those recommendations continued to move forward, that those recommendations were still appropriate. They just kind of fell flat.”

The authority would focus on things like cost, quality, innovation and access to health care, according to the proposal, and would only require one full-time paid position: an executive director. 

“The mission of this group is to engage in collaborative decision making for improved health outcomes and economic diversification,” Davis told the Legislature’s Joint Labor, Health and Social Services Committee while introducing the concept Monday. “If you don’t have health care in an area, it’s really hard to have economic development and stability.”

There were plenty of concerns voiced during Monday’s meeting, though, largely from members of the Wyoming Freedom Caucus and other far-right politicians. Questions ranged from who’d be part of this new authority to whether this new body was necessary when committees like theirs already exist.

“Some of us are concerned about what we see happening in departments and different portions of the medical community,” said Sen. Lynn Hutchings (R-Cheyenne). She also expressed concern that the proposed commission would add an extra “layer” of government. “This kind of bothers me in that you’re trying to alleviate a process that seems to be working really well.”

Davis countered that she didn’t believe today’s system is working that well.

“I respectfully disagree,” she said. “I think sometimes constituents maybe come forward to all of you and you hear one side of the issue and not necessarily all the sides of the issue, and sometimes that results in policy that doesn’t work for everybody.”

The committee voted 8-6 to draft bill language to form a healthcare authority. Legislators intend to review and vote on that legislation at their next meeting in June. 

History and conflicts of interest

Like now, the state’s previous commissions on health care reform sought to address the rising cost of medical care in Wyoming.

“[I]n 1993, 126,000 residents were paying more than 20% of their household income on health related expenses, while data from 2021 shows that 13.5% of our adult population are not seeking care due to the high cost of healthcare in Wyoming,” the task force proposal says. “Regardless of the previous commission’s efforts, Wyoming has fallen flat in improving cost and accessibility to healthcare services.”

So now, the governor’s health task force is recommending a permanent group that continues the work task force members have been doing individually for the last few years. Since the task force is Gov. Gordon’s initiative, it could end with him.

But skeptical lawmakers at Monday’s meeting questioned who’d be part of this commission and what views they hold. 

“Are you aware they elect us to protect them from the experts?” asked Sen. Anthony Bouchard (R-Cheyenne). “I’d like your view on regulatory capture and how these kind of committees actually pull that industry in where the experts get to have the say and maybe control it for better profit or profitability on their end. And that becomes a driving force.”

Good policy comes from a comprehensive approach with both sides providing expertise via first-hand experience, Davis said. But, she noted, many legislators aren’t working in health care every day, and this authority will have the flexibility to hear hours of testimony from both sides of every issue. 

“So I do think experts are necessary,” she said. “How we define experts is different, depending on what side of the issue you’re on, and that’s OK. We have to have those discussions.”

Bouchard was unconvinced, referencing how those who questioned COVID-19 policies were denounced by experts. Bouchard was one of the loudest critics in Wyoming of the government’s response to the pandemic, at one point suggesting then White House Chief Medical Advisor Dr. Anthony Fauci should be executed.

“I’m quite frankly appalled thinking that we’re going to get experts in a room and come tell us how it’s going to be because they have better views,” he said. “How is having a certain group of experts, hand-picked experts, hand-picked, going to help us decide when everybody has an agenda.”

The commission as proposed would include only nonpartisan members appointed by the governor, including a licensed nurse, physician, hospital administrator, EMS provider, business owner, a dean or administrator in higher education, and a Wind River Indian Reservation tribal member, among others.

It would also include “ex-officio” members, including in part: Davis, the health department director, the Department of Family Services director and the co-chairs of the Joint Labor, Health and Social Services Committee.

Freedom Caucus members also questioned whether this was being done to support passage of Medicaid expansion — Wyoming is one of 10 states that haven’t expanded Medicaid — and whether the idea for a health care authority was driven by out-of-state interests.

Davis replied that previous commissions explored similar questions going back decades and this was a Wyoming-based solution. She also stated that while Medicaid expansion has been discussed by the governor’s health task force, the Legislature has voted against it, and “I don’t think there’s one solution that solves everything.”