At least 12,000 Wyoming residents are projected to lose health coverage if President Donald Trump’s “Big, Beautiful Bill” is signed into law, health care advocates say. 

The voluminous bill inched closer to passage Tuesday when it cleared the Senate by a single vote cast by Vice President J.D. Vance. Wyoming’s two Republican senators, Cynthia Lummis and John Barrasso, both voted yes. 

“While this bill certainly isn’t perfect, it’s a major step in the right direction that further unlocks Wyoming energy and delivers significant wins for working families across Wyoming,” Lummis said in a statement. She released a tally of industries and areas that stand to benefit from the bill, which included coal, livestock and rural economic development. 

Meantime, opponents are ringing the alarm bells on legislation they say will have devastating health care impacts on the nation’s low-income residents. In Wyoming, they say, that will mean more uninsured patients, climbing health care costs and mounting pressure on already-strained rural hospitals. 

“The cuts to Medicaid and the [Affordable Care Act] will have devastating and dramatic impacts on health coverage, care, and costs for American families, and in many ways, especially in Wyoming,” Anthony Wright, executive director of Families USA, said in a statement. “The cuts will not just mean that tens of thousands of Wyoming residents lose coverage, but federal cuts will force state budgets into crisis, forcing states to drastically scale back services, leading to closures of rural hospitals and community clinics.” 

​​The president’s enormous tax and spending bill has implications for an array of policies. Along with slashing Medicaid spending, it sets aside money for immigration enforcement, including mass deportations, extends tax cuts and axes spending for the Supplemental Nutrition Assistance Program, which helps low-income people pay for food. 

Coverage

The bill is projected to reduce federal Medicaid spending by $793 billion over 10 years, resulting in 10.3 million fewer people enrolled nationally, according to the Congressional Budget Office. Changes include increased work requirements and potential penalties for states that have expanded Medicaid. 

Wyoming is one of the few states that hasn’t expanded Medicaid and so would avoid some immediate hits, said Josh Hannes, vice president of the Wyoming Hospitals Association. However, impacts are still expected here, he said.

“Some of the concerns for us are around reducing the proactive look-back period of Medicaid from 90 to 30 days,” he said. That change would cut two months off the current provision that allows Medicaid patients to get coverage for health care costs incurred during the three months prior to their enrollment. 

The Wyoming Medicaid program covers 62,000 patients, according to Families USA. Some 46,000 residents, meanwhile, get health insurance through the Affordable Care Act marketplace coverage, which is available for people who don’t qualify for Medicaid and don’t have insurance through an employer.

Another big worry, Hannes said, is related to enhanced premium tax credits on the Affordable Care marketplace. Those are set to expire at the end of 2025 — and the bill does not renew them. 

Since 2021, when those credits were enacted, Hannes said, “we more than doubled our enrollment on the marketplace … because it provided greater subsidies to more people.” 

Without those subsidies, he said, thousands of people are expected to lose their ability to afford insurance premiums. “It’s a big concern,” he said. “We already have one of the higher uninsured rates in the country, and this will make it worse.”

Nate Martin, executive director of Better Wyoming, honed in on the tax-credit related costs in a recent opinion piece for WyoFile. “Currently, a single person earning $62,000 a year in Wyoming can buy a year’s worth of medical insurance for $5,270 thanks to Marketplace tax credits,” he wrote. “If the Big Beautiful Bill eliminates those credits, that price will increase to $11,810, according to the Center on Budget and Policy Priorities.”

The hike would be even more dramatic for older Wyoming residents who aren’t quite eligible for Medicare, Martin wrote. “Right now, a 60-year-old couple earning $80,000 a year together can buy health insurance from the Marketplace for $6,970 to cover both of them. Again, this is thanks to tax credits. Under the Big Beautiful Bill, the cost will shoot up to $44,392 a year just for insurance premiums.”

Hospital, clinic strain 

The bill poses significant damage to rural health care in particular, four Democratic senators stressed in a June 12 letter to Trump. A majority of adults living in rural areas are concerned about the cuts, according to the letter. 

“They are right to be worried, as these cuts will have devastating consequences for health outcomes and costs, jobs, and the economic success of rural communities,” the letter stated. 

Too many rural hospitals are already operating on the brink, they said, pointing to data from the Sheps Center that identifies more than 300 at-risk hospitals across the country that the senators assert would be further endangered by the cuts. 

Wyoming hospitals are all vulnerable, Hannes has said, due to the challenges of operating rural health care. Low patient volumes, administrative burdens from insurance companies, high rates of uninsured patients, rising labor costs and increasing prescription drug prices create a difficult landscape for financial sustainability, he said. In addition, Wyoming’s 15 hospital districts are facing steep property tax revenue cuts thanks to a new state law. 

Facilities like the Downtown Clinic in Laramie would also certainly see impacts, according to a recent op-ed by its director, Pete Gosar. The clinic serves low-income, uninsured patients, including those without Medicare, Medicaid or VA benefits. 

“We are proud to do this vital work, and 90% of our funding is derived from privately raised dollars,” Gosar wrote. “But how, I ask, do you expect an additional 12 to 16 million people to enter this system without a shred of additional financial support? This puts clinics like ours in an utterly precarious situation.”

Gosar called the damage to rural health care “catastrophic.” 

“If Congress truly wished to support rural healthcare, they would ensure people have access to healthcare in the first place, rather than offering inadequate props after inflicting such profound damage,” he wrote.

Presidential promises

Barrasso, who is Senate Majority Whip and a physician by training, has repeatedly celebrated the bill as a win. It translates into tax cuts and less government spending, he posted on the social media platform X, which means more money in the pockets of Americans.

In a Monday interview on Fox News, Barrasso addressed Medicaid when he said millions of undocumented Americans are on the federal program. 

“We need to stop that,” he said. “Taxpayer dollars should not be going for Medicaid for illegal immigrants.”

Undocumented immigrants are not eligible for Medicaid or other federally funded coverage, as reported by KFF Health News.

Following Tuesday’s Senate vote, Barrasso posted another triumphant message. 

“Americans elected Republicans to make our country safer, stronger, and more prosperous,” he wrote. “This bill does it.”

Critics, however, believe it will do the opposite. The organization Healthy Wyoming has been focused on expanding Medicaid in recent years. In a May webinar, the group’s interim executive director, Jenn Lowe, emphasized the harm the bill posed to Wyoming’s precarious health care network and its largely aging patients. 

“Any cuts to Medicaid, regardless of how they are sold or justified, will result in long-term harm to children and families and will put at risk many healthcare clinics that we all rely on as we travel across this great state,” she said. 

The act now returns to the House of Representatives, which passed its own version in May. 

Trump has set a Friday deadline for the legislation to be on his desk.

WyoFile is an independent nonprofit news organization focused on Wyoming people, places and policy.