Primary Concerns: Cost, Care, and the Choices Ahead

Root Causes is a policy analysis series by the Natrona Collective Health Trust, grounded in rigorous, nonpartisan research. Each installment examines the systems, data, and decisions that shape the health and well-being of Natrona County residents by going beyond the headlines to understand why things are the way they are, and what it means for the people who live here. We believe an informed community is a healthier one. If you have a topic suggestion or question, reach out to Rachel Bouzis, Director of Policy & Learning.

The high price of care

A man in Fremont County has employer-sponsored health insurance that covers his family and three kids. No one has had any significant health complications. Yet to cover what he says is “just normal stuff,” he’s been in medical debt for 12 years. “We pay a lot for insurance,” he said. “Then when we need to see a doctor, we have a $6,000 annual deductible…That is without having any major issues.” His story is both shocking and all too familiar.

The Trust recently released polling results on healthcare from registered voters across Wyoming, including this man. Eighty-one percent of voters consider the cost of healthcare a serious or very serious problem, and this issue came out on top of a list of 20 other major challenges including the rising cost of living, suicide, and lack of well-paid jobs. Given that we’ve all heard multiple stories like the one from the man in Fremont County, these numbers are hardly unexpected. What may surprise you, though, are the ways Wyoming voters are satisfied with their healthcare. Eighty percent are satisfied with the quality of care they receive, 65% are satisfied with their proximity to care, and 63% are satisfied with appointment wait times. When Wyoming talks about not being able to access care, the barriers aren’t miles or drive time. It’s cost. We simply cannot afford to access our healthcare.

The US spends substantially more on healthcare than other comparable nations, according the Commonwealth Fund’s analysis of the 2026 Organisation for Economic Co-Operation and Development index that compares economic and social data across more than 100 countries, most of which high-income democracies.

Paying more, getting less

But this enormous investment is well worth it, because our nation is so much healthier than others, right? Of course not. In the United States life expectancy at birth is nearly three years lower than the OECD average, avoidable deaths are above average, all with one of the world’s highest suicide rates. In 1950, life expectancy was the 12th highest among populous countries; in 2020, life expectancy ranked 46th behind countries such as Albania and Lebanon. There is nearly an 8-year gap from the top life expectancy down to the US’.¹ In rural America, it’s even worse, as I wrote about here.

This isn’t lost on state legislators (they have to pay for healthcare, too). In June, the Health Insurance Affordability Task Force held the first of three sessions, bringing together state senators and representatives, agency officials, and private entities like the Wyoming Hospital Association and Blue Cross Blue Shield of Wyoming. It was legislating at its finest: well-researched presenters, pointed questions, and measured, good-faith discussion, resulting in a wise conclusion. Lowering the price of insurance is mere cost-shifting, so the expense will make its way back to consumers in a different form. The only solution is to lower the cost of care.

That much of the country is one medical event away from financial ruin should be dizzying; instead, it’s status quo. Today’s healthcare crisis has been brewing for decades, and we could point fingers until we ran out of hands to hold them. As dire as this moment is, there are feasible ways to close the gap that 81% of Wyoming feels today. But to do that, it’s going to require overhaul from everyone: federal policymakers all the way down to consumers, because population-level change is the only scale that will make a dent.

The case for primary care

Fortunately, there is a whole field of medicine devoted to improving population-level health: primary health care. Though designed to serve as the foundation of our healthcare system, primary care has largely become an afterthought. It should be the very first contact across healthcare and intended for continuity and comprehensiveness.² This beautiful description captures both the breadth, capabilities, and compassion of the field:

It works to foster population health one person at a time. Primary care serves a boundary-spanning role between individuals’ experience of health and illness and the collective of medical, social, and environmental factors that advance or impede health and healing. It provides the large majority of health care. On the basis of personal knowing that comes from seeing people in sickness and in health over time, primary care serves as a connector and a buffer within a system that can be brilliant at delivering commodities of health care but dangerous if that care is fragmented and decontextualized. Primary care serves as a bridge to targeted use of specialized services that make them more effective and limit their risks. Primary care also can serve as a link with public health and social services and environments that support population health. Primary care provides contextually tailored whole-person care that advances equity in health care and health and both buffers structural inequities and fosters the social capital and relationships needed to advance systemic change. People with social disadvantage, including poverty, persons of color, and the uninsured are more likely to receive care from family physicians, and greater access to primary care is associated with improved life expectancy.³

Primary care is a critical component to lowering healthcare costs and improving overall health because it prevents many major problems later. In the US, an increase of just one primary care provider per 10,000 people found a decrease in both infant and adult mortality as well as a 3.2% reduction in low birth weight. States with higher ratios of PCPs have lower smoking and obesity rates.⁴ Adults who regularly see a PCP have 33% lower healthcare costs and 19% lower odds of dying prematurely than those who only see a specialist.⁵

An underfunded solution

There are few, if any, healthcare improvement opportunities that hold this much promise, yet primary care is woefully underutilized, and the funding may be lagging even further. In 2023, 30% of all health spending was on hospital care; primary care was just 4.5%.⁶ By the time someone ends up in the hospital, they’re already very sick, which means a bigger financial burden and often a lower quality of life. In 2018, a study across four states concluded that 28% of the total events, 39% of ED visits, and 14% of hospitalizations were considered preventable with measures like primary care.⁷ Common reasons that patients visit the ED include lack of access to primary care providers, inconvenient doctor’s hours, and some studies have found that up to 60% of all ED visits are non-urgent and potentially unnecessary.⁸ Not to belabor the point, but patients with a long-term PCP are less likely to visit the emergency room.⁹

All those countries that spend less on healthcare with better outcomes? Nearly all of them invest substantially more in primary care.

The U.S. could save $67 billion each year if everyone used a primary care provider as their principal source of care. Every $1 increase in primary care spending produces $13 in savings.¹⁰

Of course, a silver bullet is as potent as a water gun. We need massive reforms to the existing system to maximize the potential of primary care. In 2021, the National Academies of Sciences, Engineering, and Medicine released a comprehensive assessment of primary care, including recommendations to restructure how primary care providers assess fees, increase the pipeline of providers, and integrate behavioral and social health services into primary care. It defines high-quality primary care as

the provision of whole-person, integrated, accessible, and equitable health care by interprofessional teams who are accountable for addressing the majority of an individual’s health and wellness needs across settings and through sustained relationships with patients, families, and communities.

What comes next

The Health Insurance Affordability Task Force reconvenes Aug. 13-14, and primary care is on the agenda, with presenters including the Wyoming Medical Society, longtime champions of primary care in our state. Watch the meeting. Then vote in the primary election Aug. 18. Population-level change will start at the ballot box.

Sources

1. Falling Behind: The Growing Gap in Life Expectancy Between the United States and Other Countries, 1933-2021 ↩
2. The Impact of Primary Care: A Focused Review ↩
3. The Role of Primary Care in Improving Population Health ↩
4. The Importance of Primary Care ↩
5. Using Primary Care’s Potential to Improve Health Outcomes ↩
6. The State of Primary Care ↩
7. Potentially Preventable Hospital and Emergency Department Events: Lessons from a Large Innovation Project ↩
8. Emergency Department Utilization (EDU) ↩
9. The Importance of Primary Care ↩
10. Using Primary Care’s Potential to Improve Health Outcomes ↩