When the math isn't mathing - Health care coverage's downstream economic impacts

By Rachel Bouzis, Director of Policy & Learning

Welcome to Advocacy Corner, a monthly series of nonpartisan advocacy posts by the Natrona Collective Health Trust, aimed at advancing our mission of improving the health of Natrona County residents. Each month, we explore key issues that impact community well-being, providing insights and information to empower residents. If you have a topic suggestion or question, please reach out to Rachel Bouzis, Director of Policy & Learning.

That health insurance equals better health seems like the human equivalent of 2 + 2 = 4. Not only is this a logical conclusion, but it’s also substantiated by research[1]. The link between health care coverage and jobs, personal income and GDP is less obvious. Since the passage of H.R.1, or the One Big Beautiful Bill Act, much attention has been focused on coverage, but the economic implications have been conspicuously absent from the debate. It’s a costly oversight.

The Health Care Economic Engine

Someone with health insurance is inherently more financially secure than someone without it. Coverage not only acts as a buffer against catastrophic medical bills, but importantly, it provides access to preventive care that reduces serious medical complications and expenses. Insured workers also contribute more reliably to the workforce, as they are healthier, more productive and less likely to miss work.[2]

At the industry level, insurance keeps hospitals and clinics afloat by reducing uncompensated care. Health care facilities—hospitals, clinics, and pharmacies—are important economic drivers in communities. Lost revenue from uncompensated care or reduced usage forces cutbacks in staff and in purchases from vendors ranging from equipment suppliers to IT firms to real estate services. Vendors then cut back, and the ripple spreads quickly across other industries.[3]

The fallout is clear: health care workers and everyone tied to the supply chain bring home less, which means less spending on groceries, rent, transportation, and retail goods. Reduced consumer spending, in turn, shrinks state and local tax revenues. In short, when coverage erodes, the economic consequences don’t just trickle down; they cascade.

The Local Cost of Coverage Loss

Though you don’t have to be an economist to see how this works, we brought on a team of them to study the impact of health insurance on Wyoming’s economy. The Trust, along with our partners at the Wyoming Community Foundation, Wyoming Hospital Association, American Cancer Society-Cancer Action Network and Banner Wyoming Medical Center, enlisted the experts with PhDs in economics from Regional Economic Models, Inc, or REMI, to determine how closing insurance coverage gap through Medicaid expansion would impact Wyoming’s economy. REMI is a trusted economic partner of our Wyoming State Legislature and has performed economic Medicaid research studies in more than 15 states.

The report concluded that if Wyoming had expanded Medicaid as it exists today (prior to changes enacted through H.R. 1 that will begin in 2027), Wyoming would have experienced significant economic growth. The report modeled outcomes from 2026 to 2030, and in that five-year time frame, Wyoming could have:

Raised employment by 2,200 jobs across industries including healthcare (accounting for less than half of job growth), construction, retail and administration.
Grown the state’s economy by more than $300 million in GDP.
Increased personal disposable income by more than $200 million.

If you read the report, you’ll notice that half of it details what Wyoming stands to lose by Medicaid cuts. REMI conducted this study in early 2025 when H.R. 1 was being drafted and routinely revised. To simplify some very advanced math, the report modeled equal cuts to all 50 states, which was the best information at that time. The legislation that ultimately passed ended up impacting expansion states more harshly than non-expansion states like Wyoming.

While this may seem like good news, insurance coverage in Wyoming is still going to drop. There are a few different reasons for this. First, the COVID-era enhanced premium tax credits are set to expire at the end of this year, and Congress has shown no interest in renewing them. These tax credits reduce insurance premiums that enrollees pay based on their projected income for the next year. Importantly, the money goes directly to health insurers, who then lower the monthly charge for health coverage.

The numbers tell the story. In 2024, 80 percent of Obamacare enrollees could find a plan for $10 or less per month. In 2020, before the tax credits were increased, just 36 percent of this same population could find such plans.[4] In Wyoming, there were 24,574 participants in 2020. This grew 90 percent in 2025 to 46,643.[5] Because the subsidies go directly to insurers, many enrollees aren’t even aware they’re receiving this benefit.

Without enhanced premium tax credits, nearly 50,000 Wyomingites, or around 8 percent of our state’s total population, can expect to pay an average of 75 percent more. [6] On top of losing the tax credit, prices are going up. Blue Cross Blue Shield of Wyoming has requested a 20.7 percent rate increase, and UnitedHealthcare has requested a 29.1 percent hike, both of which exceed the national median increase of 18 percent. For some context, last year’s rate increase was just 7 percent.[7]

Some enrollees, particularly the self-employed or those in rural areas, will be hit hardest. A 60-year-old couple earning $85,000 per year would see their monthly premium increase by $1,507 per month, or more than $18,000 for the year.[8]

We’re already feeling these impacts. Mountain Health Co-Op announced they would be leaving Wyoming at the end of this year, leaving 11,000 customers looking for new coverage.[9]

The Commonwealth Fund analyzed the economic effects in each state of the enhanced tax credits being discontinued. In Wyoming, we’ll be losing $207.8 million of economic output and $119.8 million in state GDP. The report estimates we’ll lose nearly 1,100 total jobs, 530 of which will be in healthcare. Because of these economic losses, state and local revenue will lose $6.6 million in tax revenue.[10]

The National Cost of Lost Coverage

Of course, we don’t live in a Wyoming-sized vacuum. While exact numbers differ depending on the source, it’s unanimous that H.R. 1 will have an outsized impact on millions of Americans. It’s estimated that anywhere from 4.8 million to 14.9 million people will lose health care coverage after Medicaid work requirements go into effect in 2027. While this seems like some fuzzy math, the discrepancy stems largely from uncertainty on how individual states will implement the requirements.[11]

What the law is unlikely to do, however, is increase the number of people working. In 2018, Arkansas implemented requirements for adults 30 to 49 to work 20 hours per week to continue qualifying for Medicaid coverage. A study concluded that although 95 percent of Medicaid recipients were either already meeting this requirement or should have qualified for an exemption,[12] about 25 percent, or 18,000 people, lost coverage.[13] This disenrollment stemmed from onerous reporting requirements, administrative errors and lack of awareness. The work requirements did not increase employment.[14]

Nationally, if coverage loss is on par with Arkansas, the Commonwealth Fund estimates that 39 percent of expansion enrollees will lose coverage, even though only 13 percent of enrollees either don’t meet work requirements or qualify for an exemption. Or, for some easier math, two of every three enrollees who will lose coverage shouldn’t.[15]

According to a May 2025 study by the nationally renowned Perryman Group, losses include $329.2 billion in annual gross product and nearly 3 million jobs. Notably, this analysis accounted for any potential fiscal savings and was conducted prior to passage of the final legislation, which ultimately cut Medicaid further.[16]

Where the Numbers Don’t Add Up

This massive piece of legislation has been mercurial from the outset, and there’s already been legislation proposed to reverse some of the cuts.[17] I’ve thrown a lot of numbers at you from more than a dozen sources, including our own localized, original, commissioned study just on Wyoming. But the truth is we won’t know outcomes until the policies take effect. Some of these numbers may not always add up, and I’ve tried to explain those discrepancies (let me know if I haven’t).

What’s important to take away from this isn’t necessarily the statistics or data points. If you’re looking for the TLDR summary, here’s the key takeaway: there is economic gain when people are insured and economic loss when they aren’t.

The Most Important Calculation

At the end of the day, the spreadsheets and projections all point to the same truth: when people have health insurance, they are healthier. Coverage provides preventive care, stability during crises, and the chance to live fuller lives. While the numbers show how insurance strengthens economies, the most important equation remains the simplest: coverage means better health. And that is why protecting and expanding access to health insurance must remain at the center of efforts to build a stronger, healthier Wyoming.

[1] The Importance of Health Coverage

[2] The Relationship Between Work and Health: Findings from a Literature Review

[3] The Cost of Eliminating the Enhanced Premium Tax Credits

[4] Enhanced Premium Tax Credits for ACA Health Plans: Who They Help, and Who Gets Hurt If They’re Not Extended

[5] Enrollment Growth in the ACA Marketplaces

[6] Individual market insurers requesting largest premium increases in more than 5 years

[7] How much and why ACA Marketplace premiums are going up in 2026

[8] Who Might Lose Eligibility for Affordable Care Act Marketplace Subsidies if Enhanced Tax Credits Are Not Extended?

[9] Mountain Health Co-Op, One Of State’s Few Major Insurers, Pulling Out Of Wyoming

[10] The Cost of Eliminating the Enhanced Premium Tax Credits

[11] Medicaid Work Requirements Will Take Away Coverage From Millions: State and Congressional District Estimates

[12] Medicaid Work Requirements in Arkansas: Two-Year Impacts On Coverage, Employment, and Affordability of Care