Affordabiliy of individual market premiums in 2019

High health insurance premiums are walloping Wyoming’s middle class.

A new Kaiser Family Foundation report shows that the Cowboy State has the highest average premiums in the nation for individuals who do not qualify for subsidies. For example, a 40-year-old in the state who makes $50,000 would pay about 14 percent of that yearly income in premiums for the cheapest plan.

The problem worsens with age. The Affordable Care Act allows premiums for older adults to be three times those for their younger peers. In Teton County a 60-year-old with the same annual income of $50,000 could end up paying as much as $1,237 a month for the lowest-cost plan — 30 percent of that annual income.

That’s not affordable, according to the Affordable Care Act.

“At least in the law, between 8 and 10 percent is approximately what is considered the upper end of affordability,” said Cynthia Cox, who researches the ACA and is one of the report’s four authors.

“In some ways, this information isn’t breaking news,” Cox said. “I think people know there are affordability challenges with the ACA if you don’t qualify for subsidies. We wanted to show who those people are and put a face on it in a way.”

The majority of people who purchase health coverage through Affordable Care Act exchanges receive tax credits to help them afford their monthly premiums. The subsidies often rise with premium increases. But those who make just a little too much — anything over 400 percent of the federal poverty line, which is $48,560 for an individual and $100,400 for a family of four in 2019 — aren’t eligible.

“The whole 401 percent of poverty thing is just a result of the ACA and how it works in a small, rural state,” said Wendy Curran, vice president of care delivery and provider affairs at Blue Cross Blue Shield of Wyoming. “It is hard. I feel greatly … the percent of income is just boggling.”

It is often referred to as a “cliff” because subsidy eligibility isn’t phased out. Healthcare navigator Joe Albright helps people wade through the enrollment process and has seen those teetering on the proverbial cliff.

“I’ve talked to dozens of people who face this exact problem,” Albright said. “Most people who are right on the borderline have to think about whether there’s a way they could work a little bit less so they could qualify … that might mean the horrible choice of having to earn less in order to be able to get affordable health insurance.”

The report looked only at premiums for plans available through the ACA marketplace, although other plans are available. Bronze premiums (the lowest-cost plans available) for people who are not eligible for subsidies are generally similar whether an enrollee buys through the marketplace or not.

Rural areas are hit hard

Another state with similarly staggering premiums for those who fall off the cliff, so to speak, is neighboring Nebraska. Cox said several factors affect rural states, whose residents often have higher premiums and then, in a double whammy, people have to pay the amount themselves. Small-business owners, farmers and ranchers are unlikely to receive coverage in the same way an employee for a large business in a city would.

“Part of it is people who live in rural areas might be older and sicker on average than people who live in urban areas,” Cox said. “They also just tend to be more dependent on buying their own coverage as opposed to getting coverage from an employer.”

Cox said the lack of competition, both for insurers and hospitals, drives up health care costs in remote areas.

Despite also being a large rural state, neighbors in Idaho across Teton Pass pay much less in premiums. A 60-year-old in the same situation described earlier pays 17 percent of their income in Teton County, Idaho. That’s because sparsely populated states with urban centers like Boise usually have more insurers participating in the exchange. Counties in Idaho have access to either three or four insurers that participate in the ACA, not just one like Wyoming.

Cox said that even states like Nevada, where most counties have only one provider but counties near Las Vegas have two, have more leverage than Wyoming.

Solutions have pros, cons

Released last week, the Kaiser report lists a multitude of potential solutions to the crushing premiums, including more loosely regulated short-term plans, creating a state-based reinsurance program, extending and tapering subsidies past 400 percent of the poverty line and expanding Medicaid (which failed this year in the Legislature) or Medicare.

“I don’t know there’s a one-size-fits-all approach to this,” Cox said. “But we wanted to highlight the pros and cons of the different options that are available.”

Wyoming Republican Sen. Mike Enzi’s press secretary, Rachel Vliem, said he supports lowering health care costs through a competition-oriented, market-based approach.

“Sen. Enzi supports proposals that could improve access to affordable, high-quality health care and offer new protections so that consumers, including folks with pre-existing conditions, can afford quality health insurance coverage,” she said. “He doesn’t believe the Affordable Care Act has helped achieve those goals and is working with his colleagues to bring about a better system.”

His Republican counterpart Sen. John Barrasso also expressed discontent with the Affordable Care Act and the individual mandate tax, which has been eliminated.

Looking at the options

“The high cost of health insurance in Wyoming and across the country is unacceptable,” Barrasso said in a statement through his deputy communications director, Laura Mengelkamp. “It’s clear that Obamacare has failed terribly. Americans have seen fewer choices, higher premiums — and, in several states, including Wyoming — only one option for insurance.”

He introduced a bill in Congress on March 7, the Improving Choices in Health Care Coverage Act, that would expand access to short-term, limited-duration health plans.

Demographics and state politics can limit what solutions are feasible in the West. Some states have considered rearranging their rating areas, merging high-cost areas with low-cost ones to average premiums. But every county in Wyoming is high.

Short-term plans can give people cheaper options but can deny people based on pre-existing conditions or charge based on health status. Generally speaking, they attract healthier people — therefore having an upward effect on premiums in the ACA-compliant market as the sicker patients remain.

Association health plans are another choice. The population risk and therefore the premiums would depend on what kind of groups got together — anything from religious organizations to ranchers. But association plans can be “robust and comprehensive,” according to Cox, and there’s been discussion in Teton County of larger organizations banding together to offer insurance.

Barrasso said that he supported President Donald Trump’s executive order in 2017 that promoted more choice in association health care plans, short-term health plans and health reimbursement arrangements. Enzi has also supported allowing small businesses to pool together to provide health insurance for the last two decades.

Reinsurance is an option that Cox has seen receive bipartisan support across the country — Alaska, Maine, Maryland, Minnesota, New Jersey, Oregon and Wisconsin have created their own programs. Reinsurance is essentially insurance for insurers that allows a portion of health care expenses for high-cost patients to be covered by another party, allowing premiums to be reduced.

Blue Cross Blue Shield of Wyoming likes the concept, but it hasn’t taken hold in the state yet. Efforts in Cheyenne to create a reinsurance plan with Legislative approval passed the House but failed a Senate vote this year.

“We’re very aware of this problem, and that’s one of the reasons we had supported legislation this year about a state reinsurance plan, which was designed to provide some relief for individuals who are in the unsubsidized category,” the insurer’s Curran said.

She said her organization would continue to work with the insurance community and the government to “see what else we might be able to do.”

This story has been updated to correct the name of one of the report's authors. — Eds.

Contact Kylie Mohr at 732-7079, or @JHNGhealth.

Kylie Mohr covers the education and health beats. Mohr grew up in Washington and came to Wyoming via Georgetown. She loves seeing the starry night sky again.

Recommended for you

(14) comments

Chad guenter

Since the "affordable" Care Act, we have gone from the best healthcare system in the world to a chaotic, unaffordable mess for all.

Premiums is only half the issue. DEDUCTABLES make health "insurance" no insurance at all. Unless you have a major problem, EVERY visit to the doctors is paid out of your own pocket.

What the government and politicians have done to the middle class WORKERS of this nation is a crime. The politicians should be in prison.

rich quinlan

Every other major democracy has figured it out , the US is like your stubborn grandpa who wont listen to an idea that works everywhere else at a lower cost than YS healthcare.

Ken Chison

Interesting comment Rich. I wonder what countries you refer to. No one here even touched on the number burden to the US health Care system. A little thing called emtala? Illegals are a huge drain on the system. They can not be denied an emergency room visit. In Colorado alone, 80percent of illegals have no health insurance. I would imagine it to be just as high in all southwestern states. So guess what? It's up to legal, working ng people to pay for them. See, free stuff always costs someone. And it's usually the person doing things right. The US pays in more, per capita, for health care than any other country. Then factor in what doctors have to pay for malpractice insurance, with all the sue happy lawyers we have, and it goes to show the difficulties at hand. My insurance all but doubled under obama, which made me go out of into an Hsa. Higher deductibles and less coverage. Doe the near future, there is no answer. Govt is not the answer. But, getting the freeloaders off of the system would be the first huge step in the right direction.


I've heard the argument that everywhere else is better than here, but I don't hear the same from the people actually living in the places that are supposedly better. I have a brother-in-law whose uncle was in Canada that needed to wait 3 months for a heart surgery. He lived in Quebec and needed to travel to Montreal to have the surgery. I worked with Canadians here who would have there surgery here. Why not in Canada? Answer was no way. There was a guy from the Neatherlands who created a very popular Open Source software, then changed the license to demand payment. He received a lot criticism, then responded that his son needed several surgeries that the national plan would not pay for. Obviously, he was pretty upset that the same plan that he paid taxes into wouldn't do anything for him. I have used an eye surgeon that gets a lot of out of town business. I've heard some are royalty where they come from, obviously prefer the care here rather what their government can provide. I had a neighbor who did pull up and leave, but when he needed surgery he came back to the neighborhood. Let's face it, the cost of medical care here is oppressive, but we are not seeing an exodus. Also, I disagree with the article. I shopped health insurance among three states and Wyoming was the cheapest, in one case, by quite bit. Yes it is high here, but I don't see it as the highest. So I am thinking that the study cited in the article was selected or politically tainted.

rich quinlan

In the report, the US “ranked last overall among 11 industrialized countries on measures of health system quality, efficiency, access to care, equity and healthy lives.” Significantly, the US was noted to have the highest costs while also displaying the lowest performance.Feb 11, 2016


Health insurance is expensive no matter how you cut. If you look at your EOBs the costs are phenomenal. Probably less here than in other places that I have seen. The government plans don't offer enough choice. Some states have no choices. Many believe that goverment offered plans are the only choice, so these plans aren't competitively priced. Medicare isn't self supporting now and the first trust runs out in 2026. Many doctors are not accepting new Medicare patients and there is a new trend sweeping the nation call concierge care. This is hiring a physician and paying a retainer. The retainers are not covered by insurance. In some areas you can no longer find a GP without paying the retainer. Medical care is going to get more expensive, you can expect insurance premiums to go up too. Couple this with those who receive care but don't pay the bill, assume costs will go up for everyone else.

rich quinlan

Ive been on all sides of this first as one who could not buy insurance because of heart issues. Went 7 years without as a contractor and just hoped nothing serious would happen , then thanks to Obama we got AHCA , i didnt get much subsidy but did get solid BCBS insurance with my last premiums in the 600 dollar range. Had heart surgery , ablation , and Im all better , no more paramedics to the house twice a year . Obama probably saved my life. Now retired and on Medicare , we buy a supplemental for about 175 per month each , plus the cost of part B at around a hundred a month. So we pay approx 250 a month in retirement for an excellent coverage plan. Ive also come to believe that anything a republican says about healthcare is either a lie or total BS. They dont care at all. Medicare is awesome just fund it as necessary . The real shame in our country is the total lack of coverage for memory care of our elders. Were caretaking a mom and the choices are basically none and none. 8k a month for memory care , really ? I wish this country actually cared about our elders and kids and stopped needless waste on giving the uber rich tax cuts and corporations a total free ride. Also to the scab companies who don't provide insurance to their employees , come on man !

Judd Grossman

The interesting thing is that the amount you paid in premiums has no relation to the actual price of healthcare which means the actual costs are being shifted to the people that are paying unsubsidized premiums and to the taxpayers. Until we create an efficient market in healthcare some folks will get a great deal, but other folks will be left holding the bag. My family of four's 2018 BCBS premiums were going to be $2,800 per month with a $13,000 out of pocket maximum, so I canceled the policy and became uninsured. Insurance is supposed to protect your life savings not destroy them. I'm convinced that insurance for non-catastrophic expenses causes massive price inflation and is a significant contributor to the ridiculous disconnect in healthcare pricing.


Some states have seen enrollments decrease as hiring picked up and people joined the employer's group plan. Small business were hit hardest by AHA, where their small plans in some cases doubled in a single year forcing them to abandon the plan and some just sold to a bigger outfit so they could get on their plans. Massachusetts is trying to force people out of the group plans to boost their enrollments. My employer offers an AHA quailifed plan, but Mass made laws that increased the minimum quailifications such that our Mass employees are accessed a tax penalty (yes they have their own in addition to the Federal penalty) even though they are covered by a suitable plan. All the AHA plans are expensive, some states worse than others, but what is really sick is trying to force people to buy them even when there is a better alternative. I shouldn't have to tell you how Massachusetts leans.


When my COBRA ran out, I bought insurance off the exchange. It was an unapproved plan, but the policy of the current administration is to stand down on asessing penalties. Exchange plans are significantly more expensive than private plans.

Judd Grossman

The ACA is a disaster for the middle class. All third party payer solutions, whether they are insurance or government subsidies, contribute to price inflation. Currently, prices have no relation to what average people can afford. The only way to get prices under control is for consumers to pay directly for their own health care. Consumers with skin in the game shop carefully for price and value and the market will be forced to respond.

rich quinlan

Insurance was broken before the ACHA , Insurance companies had been hammering businesses each year on renewal. I was a GM at a plant in the mid 90's and we had an employee that had pre-MS and needed interfuron treatment. 100k per year , next year our rates went up 100k + 15% , they were gonna make their money come heck or high water. But i guarantee that rate would never decrease. Its too convenient to blame ACHA , it was broke long before that. We used health insurance as a benefit and perk to hire solid employees , todays employers who dont/ or wont provide benefits should be seen for what they are , bad employers.

Sheryl West

I get sick to my stomach when I think about my health insurance. Yes, at 59, I'm in with the infographic's old geezer in glasses and my bill of $1,175. And dealing with said 'loosely regulated short-term plans' is NOT an option. At this age we surely have some pre-existing conditions. One such carrier I spoke to said they would likely reject me because I've had 2 breast biopsies (no cancer found). I wonder how many folks like me contemplate crossing our fingers, cancelling our health plans, and hoping we're healthy until Medicare kicks in. Though based on Medicare cuts in the news, I'll soon have something new to worry about! I'd better hit the treadmill.

jeff birmingham

Ya i feel you pain we are now paying double what we were before all of this AHC came to be. So much for affordable are keeping your DR and plan. I knew soon as the GOV got involved we working class were going to be paying the bill for those that don't even worst than we already had been.

Welcome to the discussion.

Please note: Online comments may also run in our print publications.
Keep it clean. Please avoid obscene, vulgar, lewd, racist or sexually-oriented language.
Please turn off your CAPS LOCK.
No personal attacks. Discuss issues & opinions rather than denigrating someone with an opposing view.
No political attacks. Refrain from using negative slang when identifying political parties.
Be truthful. Don’t knowingly lie about anyone or anything.
Be proactive. Use the “Report” link on each comment to let us know of abusive posts.
Share with us. We’d love to hear eyewitness accounts or history behind an article.
Use your real name: Anonymous commenting is not allowed.