JACKSON HOLE, Wyo. — Like millions of other Americans, Stacy Newton turns to Healthcare.gov to shop for health insurance for her family. The Affordable Care Act website, according to the government, is where consumers are supposed to find “a menu of health insurance plans.”
But for the Newtons and many others in the country, next year’s menu is severely limited: There is only one company offering ACA plans here — and costs have risen steeply.
To continue health coverage for themselves and their two teenage children, the Newtons would have to pay an annual premium of $43,000 — about a third of their gross income. It is the price of the cheapest plan available to the family from Blue Cross Blue Shield of Wyoming, the only ACA insurer left in Teton County.
This year, millions of American families that have relied on ACA, popularly known as Obamacare, are being squeezed on multiple sides: Premiums are rising, the covid-era subsidies that helped pay for those policies are shrinking, and there are fewer choices with insurers pulling out of some markets.
The squeeze here is a symptom of broader trouble in American health care. In western Wyoming and other regions, the expected rollback of enhanced subsidies has destabilized the economics of Obamacare, pushing some insurers to retreat from the government-supported market because it won’t be profitable.
That is leaving consumers like the Newtons with little choice but to buy a pricey, unsubsidized policy from a local monopoly.
Next year, the number of counties with only one company providing Obamacare will jump from 72 to 146, according the Robert Wood Johnson Foundation. That number is expected to rise further if, as appears likely, Congress fails to renew the enhanced subsidies.
Newton and her husband, Derek, each run a small business — she is an independent sales representative, and he outfits vans — and like many entrepreneurs, they have relied on the ACA for health insurance. But this year, the price of their policy rose 34 percent, and the federal subsidy that helped them pay for it is slated to go away. At the same time, they know they will need medical care: Last year, Newton, 51, was diagnosed with chronic leukemia.
“It’s terrifying,” she said. “We’re not rich, we’re not poor. We’re a standard, middle-class family, and somehow now I can’t afford health insurance.”
This year, the enhanced subsidies that helped middle-income people afford Obamacare plans have been stuck in partisan congressional deadlock. The subsidies expire Dec. 31, and Republicans, who hold the majority, have opposed extending them.
Anticipating that sticker shock will induce healthy people to drop out of insurance and saddle health plans with a higher proportion of the sickest, costliest patients, insurers say they must dramatically raise ACA prices or pull out of Obamacare marketplaces altogether.
Without the enhanced subsidies, “I would expect more insurers to retreat, to exit,” said Katherine Hempstead, a senior policy officer at the Robert Wood Johnson Foundation. “People will see less choice and higher prices.”
According to economic studies conducted in 2017 and 2018, another turbulent period when Obamacare insurers faced losses and political uncertainty, prices rose between 30 and 50 percent when an area was reduced to only one ACA insurer.
The problem here in Teton County began in August when the only other insurer providing ACA coverage, Mountain Health Co-op, announced it was pulling out, citing the looming expiration of the enhanced subsidies. Of the roughly 46,000 people on Obamacare in Wyoming, about 11,000 are expected to drop coverage, according to insurers.
“The basic problem with reducing the subsidies is that healthier people say ‘we can’t afford insurance’ and drop out, while the sicker population are, like, ‘oh, my god, I still need it,’” said Alexander Muromcew, a board member of the Mountain Health Co-op. “As an insurer, you end up with a smaller and higher-risk membership, which is not sustainable.”
Muromcew said competition had been good for consumers, noting that when Mountain Health entered the market here a few years ago, Blue Cross Blue Shield dropped its prices. Now, as a monopoly, he said, Blue Cross Blue Shield has more power to dictate prices.
“Without competition, I worry that it’ll be easier for Blue Cross Blue Shield to raise rates even further,” Muromcew said.
Diane Gore, president and chief executive of Blue Cross Blue Shield of Wyoming, said she understands the frustration of people getting hit with rising premiums and lowered subsidies.
“I get it, I completely get it,” Gore said.
The company says its prices are the same across most of Wyoming, regardless of whether there is a competitor. Gore attributed this year’s price hikes, which she said were 25 percent on average, to the expectation that the remaining Obamacare customers will be sicker, and to the rising cost of medical care in rural areas, where health care providers are scarce and competition is often limited. Of every premium dollar the company collected last year, she said, 95 cents went to direct medical care.
Insurance companies don’t always find Obamacare markets profitable. Aetna, one of the largest insurance companies, announced earlier this year that it was dropping ACA coverage in 11 of 15 states. The move affected about a million Obamacare customers.
“I understand that there is rhetoric from the Beltway that the insurance companies are getting rich off of Obamacare,” Gore said. “But that’s not this insurer in Wyoming.”
‘Clearly, the system is broken’
Many people in this resort town are seasonal workers, self-employed or small-business entrepreneurs. Lacking employer insurance plans, they have come to rely on Obamacare. Among them, the anxiety is widespread.
“Clearly, the system is broken,” said Heather Huhn, an insurance broker in Jackson.
On her desk, she has a stack of files with the applications for about 30 families that she calls the “Hold Tight” pile. They are mainly people who have ongoing medical needs, such as chronic conditions or expensive prescriptions, and can’t afford to pay for health insurance at the current costs. For weeks, she said, they have been desperately waiting to see whether the government will extend the enhanced subsidies that began during the pandemic.
“They sit across from my desk and say, ‘I just don’t know what to do,’” Huhn said. “I tell them not to have a mental breakdown just yet. People are having to suffer because the government can’t figure out how to fix it.”
Sophia Schwartz, a professional skier and health care administrator here, senses similar apprehension. For years, she has been inviting groups of “ski friends,” many of whom have irregular jobs, over for dinner to counsel them on how to get health insurance.
“This was the scariest year I’ve ever done it,” said Schwartz, a former member of the U.S. ski team and now a big-mountain skier. “People came to me in pure panic.”
Considering ‘BearCare’ and other options
In desperation, many are turning to stopgap measures.
Some, especially skiers, were looking at policies at a company called Spot Insurance that cover reimbursement of medical bills incurred after accidents on the slopes. Others were looking at “healthshare” groups in which members contribute monthly to cover each other’s eligible medical bills; among the drawbacks of these programs is that elective surgeries and nonemergency treatments may not be covered.
And some were considering “short-term” insurance policies. Those are closer to conventional health insurance, but those insurers may reject applicants with medical conditions such as diabetes, heart disease or cancer.
With so many in Wyoming searching for answers, even the state is jumping in. State officials have proposed “a major medical plan” they have called “BearCare.” The policies would, at “a significantly lower price,” cover emergency situations such as “being attacked by a bear” and other more common medical catastrophes. It would not cover ongoing or chronic medical needs.
Some of those looking for conventional health insurance say the state proposal is woefully inadequate.
“I don’t worry about being bitten by a bear, I worry about getting cancer,” said Margie Lynch, 58, an energy efficiency consultant based here. For the cheapest Obamacare plan, she would have to pay $1,585 a month. Its benefits would not kick in until she paid a deductible of $10,600.
“The cost of the premium is almost as much as my mortgage,” Lynch said. “I’m lucky enough to be able to pay for it if I have to. But there are so many people out there who won’t be able to.”
Newton, Lynch and others here have shared their concerns with Wyoming’s representatives in Congress: Sen. John Barrasso, Sen. Cynthia Lummis and Rep. Harriet Hageman. All three Republican lawmakers have opposed Obamacare and criticized Democrats, who have pushed to extend the enhanced subsidies.
“Stacy’s story and experience is one of the many heartbreaking examples of how Obamacare has failed families across Wyoming,” a statement from Barrasso said. “Instead of working with Republicans to make health care more affordable for all Americans, Democrats would rather use more taxpayer dollars to bail out Obamacare and hide its failures.”
A spokesman for Lummis said, “The health care problem Americans are facing is a direct result of the Democrats’ failed Affordable Care Act — Sen. Lummis had the foresight to oppose this misguided legislation from day one.”
A spokesperson for Hageman said in a statement that “Rep. Hageman knows there are many people struggling with the weight of medical expenses, and the catastrophic failure of Obamacare is making it far worse.”
The squeeze
For years, Obamacare had worked well for the Newtons.
In 2017, when the couple were starting their businesses, their income was low — about $56,000. The price of their policy was $1,585 per month, but the standard ACA subsidy covered most of that, and the couple had to come up with only $332 monthly.
Since then, however, the prices of the premiums have risen steadily, and now, because of the expected subsidy reductions, they would no longer qualify for government help. They would have to pay full price — $3,573 monthly for the cheapest option. Even at $43,000 a year, the plan carries a $21,200 deductible, according to the paperwork Stacy Newton showed The Post.
Earlier this month, the couple struggled with whether to pay that to Blue Cross Blue Shield of Wyoming, go without health insurance or find some other stopgap option. Newton was getting notices that said, in bold red lettering: “Important — You’re about to end (terminate) this coverage. If any of the people above get health care services or supplies after 12/31/2025, they’ll have to pay full cost.”
Eventually, Newton knows, she will need leukemia treatment. She’s just not sure when.
“If my leukemia acts up, I’m up a creek,” she said earlier this month. “I just don’t have a solution yet.”
On Monday, she sent a text.
“I just officially canceled my ACA marketplace insurance for 2026,” she wrote. “How on earth is this going to unfold for millions of people in America?
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