CASPER, Wyo. — Wyoming ranks 29th in the nation for overall health, according to the America’s Health Rankings 2025 Annual Report. That middling score hides a sharper story, and Wyoming voters have the power to change it.

Wyoming performs well on education and income equality, but it ranks 49th in cancer screening and 43rd for its uninsured rate.

At the same time, voter turnout sits at just 56.4%, below the national average, on ballots that will decide who can bridge the gap.

Those things are related, said Dr. Gabriela Alvarado, a health policy researcher at the University of Wyoming and former RAND Corp. analyst.

“All the sources are kind of saying the same thing: Wyoming health is not where it should be,” Alvarado said.

While lawmakers write the laws that shape Wyoming’s health outcomes, voters hold the power to change them. Whether it’s increasing preventative care, funding the 988 hotline, preventing maternity deserts or shortening the distance to the emergency room after a workplace accident, voting could be the difference between life and death.

Ripple effects of policy

To vote smarter, citizens need to know the candidates, their plans to tackle the state’s healthcare challenges, and how those plans translate to policy.

The connections aren’t always clear. The cancer screening rate, for instance, is tied to low HPV vaccination rates and Title X–funded reproductive health clinics, Alvarado said.

“Those clinics screen for cervical cancer and administer the vaccine that prevents it,” she said. “Cultural discomfort deepens the gap, because Americans associate the HPV vaccine with sex rather than cancer prevention.”

Wyoming’s low rates of preventive care are a policy outcome.

Wyoming is one of only 10 states that has not expanded Medicaid, a decision lawmakers have upheld session after session, excluding roughly 9,000 residents who earn too much for the state’s narrow program but too little to afford private coverage.

“That ripples over to all these other indicators,” Alvarado said. “If you don’t have insurance, you’re not going to get a colonoscopy or other forms of cancer screening.”

Dr. Beth Robitaille sees where those people end up. Robitaille is a family physician and interim chief medical officer at the Educational Health Center of Wyoming, a federally qualified health center and residency program with clinics in Casper, Cheyenne and Laramie. 

She said her clinics saw more than 60,000 provider visits last fiscal year, and roughly 20% of those patients are uninsured.

Uninsured patients who skip routine care because they can’t pay for it, Robitaille said, arrive only when their conditions have advanced. An uninsured diabetic who can’t afford checkups or insulin develops uncontrolled blood sugar. That can lead to a foot wound, then an infection.

“Those infections often end with amputation, which requires hospitalization,” she said. “That hospitalization and treatment become uncompensated care for the hospital.”

Those unpaid bills added up to $141 million in 2024–25, according to the most recent report by the Wyoming Hospital Association.

Who pays when hospitals fail?

Hospitals recoup the losses by charging insured patients more, Robitaille said. Taxpayers who oppose Medicaid expansion as a cost-saving measure are already covering the bill through premiums instead, which impact the broader community.

“The reality is we’re still paying for it,” Robitaille said. “It’s just in a different manner.”

Her clinic writes off 80%–85% of costs for its lowest-income patients through a sliding fee scale, turning a $140 visit into a $15 charge. Federal funding offsets only part of that.

Robitaille pushed back on a common assumption about who’s uninsured.

“There’s a misconception that it’s all these people taking advantage of the system,” she said. “In 25 years of caring for this population, I find that they are often employed, self-employed or working for small businesses that can’t afford private insurance.”

Michael Shepherd, a political scientist who studies how health outcomes shape politics, said uncompensated care is a leading cause of rural hospital closures nationally.

“That’s everybody’s hospital,” he said. “That’s not just the people who are on Medicaid.”

The stakes are high in Wyoming, a largely rural state in which farming and ranching — among the country’s most dangerous jobs — depend on nearby emergency rooms when workplace accidents strike. Rural residents already travel twice as far as urban patients for care. In life-or-death situations — such as strokes and heart attacks — every mile and minute counts.

Strained hospitals cut services before they close, Alvarado said, and obstetrics usually goes first.

Nearly 60% of rural hospitals nationwide no longer deliver babies. Medicaid pays for nearly half of rural births, and federal cuts under the One Big Beautiful Bill Act are expected to leave about 10 million more people uninsured by 2034, per the Congressional Budget Office.

Yes, but…

The same law created a $50 billion Rural Health Transformation Program to soften the blow, though researchers estimate it covers only about 37% of the Medicaid funding rural areas stand to lose.

Wyoming’s share is substantial. The state was awarded $205 million in the program’s first year, according to reporting by WyoFile. That’s the second-largest per-capita award in the nation, behind Alaska, and providers can apply for the funds through Aug. 3.

Eric Boley, president of the Wyoming Hospital Association, told Oil City News that those one-time funds have the potential to be “transformational for struggling hospitals.”

“We may be able to use the funds to strengthen OB-GYN and emergency services,” he said. “Studies show that, with heart attack and stroke, getting care within an hour significantly improves your chances of making a full recovery.”

A vicious cycle

So why don’t bad outcomes produce different votes? Shepherd calls the answer the “rural health spiral.”

“Poor outcomes breed resentment toward government, resentment elects candidates who campaign on it, and those candidates pass policies that worsen the outcomes,” he said. “Instead of voters rallying to correct that course, they often double down on the course that they’re on, and things continue to spiral out of control.”

Alvarado worries that voters aren’t connecting policies to outcomes. 

“Legislators are there to serve their constituents,” she said. “If we tell our legislators what it is we care about, they know that there’s votes attached to that.”

Breaking the cycle

The mechanism to repair a broken system is the ballot.

Alvarado urged voters to treat elections as a “window of opportunity” when a known problem, an available solution and political will align.

“Whoever wins decides what the Legislature takes up,” she said.

Robitaille framed the choice as a question.

“Is healthcare a right or a privilege?” she asked. “Depending on where you as an individual stand on that question would affect who you vote for.”

Her advice is to go beyond the commercials, social media posts and yard signs to learn where candidates actually stand, because healthcare touches everyone eventually.

“We all need healthcare at some point, or our loved ones do,” she said. “So it affects everybody.”

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